Provider Demographics
NPI:1548595218
Name:HEALTHEAST CARE SYSTEM
Entity Type:Organization
Organization Name:HEALTHEAST CARE SYSTEM
Other - Org Name:HEALTHEAST HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-232-2250
Mailing Address - Street 1:1655 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1163
Mailing Address - Country:US
Mailing Address - Phone:651-232-2800
Mailing Address - Fax:651-232-2898
Practice Address - Street 1:1700 UNIVERSITY AVE W
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3727
Practice Address - Country:US
Practice Address - Phone:651-232-2800
Practice Address - Fax:651-232-2898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHEAST CARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-13
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331635251E00000X, 332B00000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN433673900Medicaid
MN413993300 IVMedicaid
MN247166Medicare Oscar/Certification
MN433673900Medicaid