Provider Demographics
NPI:1770643694
Name:MARY T ASSOCIATES INC
Entity Type:Organization
Organization Name:MARY T ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-862-5436
Mailing Address - Street 1:1555 118TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-7579
Mailing Address - Country:US
Mailing Address - Phone:763-862-5436
Mailing Address - Fax:763-754-0332
Practice Address - Street 1:1555 118TH LN NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-7579
Practice Address - Country:US
Practice Address - Phone:763-862-5436
Practice Address - Fax:763-754-0332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY T INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331577251E00000X
MN801456315P00000X
MN801457315P00000X
MN801459315P00000X
MN801458315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN972525300Medicaid
MN131415OtherU CARE HHA
MN472845900Medicaid
MN612745200Medicaid
MN102207OtherHEALTH PARTNERS
MN136968OtherU CARE PCA
MN9394ABOtherBCBS
FM104337OtherU CARE FC
MN672745000Medicaid
MN642845200Medicaid