Provider Demographics
NPI:1790210318
Name:HOMEFIELD HEALTH, LLC
Entity Type:Organization
Organization Name:HOMEFIELD HEALTH, LLC
Other - Org Name:HOMEFIELD HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KNECHT-SAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C/OWNER
Authorized Official - Phone:701-356-0097
Mailing Address - Street 1:4141 31ST AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8778
Mailing Address - Country:US
Mailing Address - Phone:701-361-3838
Mailing Address - Fax:701-540-0481
Practice Address - Street 1:4141 31ST AVE S.
Practice Address - Street 2:STE 102
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104
Practice Address - Country:US
Practice Address - Phone:701-356-0097
Practice Address - Fax:701-356-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR32949261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND84223Medicaid