Provider Demographics
NPI:1710966353
Name:FAIRVIEW HOME CARE AND HOSPICE
Entity Type:Organization
Organization Name:FAIRVIEW HOME CARE AND HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALVORSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-728-2340
Mailing Address - Street 1:2450 26TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-9854
Mailing Address - Country:US
Mailing Address - Phone:612-728-2350
Mailing Address - Fax:612-728-2400
Practice Address - Street 1:2450 26TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-9854
Practice Address - Country:US
Practice Address - Phone:612-728-2350
Practice Address - Fax:612-728-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN329541251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN624555200Medicaid
MN241514OtherMEDICARE PROVIDER NUMBER
MN6012484OtherMEDICA
MN6012484OtherMEDICA