Provider Demographics
NPI:1649400961
Name:DW HEARTHSTONE HOLDINGS, LLC
Entity Type:Organization
Organization Name:DW HEARTHSTONE HOLDINGS, LLC
Other - Org Name:BENEDICTINE HOME HEALTH DULUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMMUNITY HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LAUREL
Authorized Official - Last Name:SZUMOWSKI DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-625-2307
Mailing Address - Street 1:935 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4951
Mailing Address - Country:US
Mailing Address - Phone:218-740-4290
Mailing Address - Fax:218-279-4412
Practice Address - Street 1:935 N KENWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-740-4290
Practice Address - Fax:218-279-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN367084251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN248109OtherCMS CERTIFICATION NUMBER
MN248109OtherCMS CERTIFICATION NUMBER