Provider Demographics
NPI:1497923346
Name:MARY T HOME HEALTH INC
Entity Type:Organization
Organization Name:MARY T HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-862-5426
Mailing Address - Street 1:299 COON RAPIDS BOULEVARD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433
Mailing Address - Country:US
Mailing Address - Phone:763-862-5436
Mailing Address - Fax:763-754-0332
Practice Address - Street 1:299 COON RAPIDS BOULEVARD
Practice Address - Street 2:SUITE 105
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:763-862-5436
Practice Address - Fax:763-754-0332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY T ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 235Z00000X
MN331577251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1880433Medicaid