Provider Demographics
NPI:1659379097
Name:NORTH WOODS HOME NURSING
Entity Type:Organization
Organization Name:NORTH WOODS HOME NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:VARONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-852-3736
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854-0307
Mailing Address - Country:US
Mailing Address - Phone:906-341-6963
Mailing Address - Fax:906-341-2490
Practice Address - Street 1:226 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-1426
Practice Address - Country:US
Practice Address - Phone:906-341-6963
Practice Address - Fax:906-341-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
MI11921251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE856OtherBCBS HOME HEALTH
MI2737447Medicaid
MI2737447Medicaid