Provider Demographics
NPI:1710238654
Name:FOREST LAKE HOME CARE INC
Entity Type:Organization
Organization Name:FOREST LAKE HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KREGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-272-5195
Mailing Address - Street 1:631 LAKE ST S
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2631
Mailing Address - Country:US
Mailing Address - Phone:651-272-5195
Mailing Address - Fax:651-395-2934
Practice Address - Street 1:631 LAKE ST S
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2631
Practice Address - Country:US
Practice Address - Phone:651-272-5195
Practice Address - Fax:651-395-2934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health