Provider Demographics
NPI:1639543036
Name:HENNEPIN HEALTHCARE SYSTEM, INC
Entity Type:Organization
Organization Name:HENNEPIN HEALTHCARE SYSTEM, INC
Other - Org Name:HENNEPIN HEALTHCARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-873-5340
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:P1-FINANCE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-3000
Mailing Address - Fax:612-904-4259
Practice Address - Street 1:2000 SUMMER ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2648
Practice Address - Country:US
Practice Address - Phone:763-531-2424
Practice Address - Fax:763-531-2422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENNEPIN HEALTHCARE SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-23
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN369767251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN194092900Medicaid
MN241533Medicare Oscar/Certification