Provider Demographics
NPI:1891789079
Name:HOSPICE OF THE TWIN CITIES, INC.
Entity Type:Organization
Organization Name:HOSPICE OF THE TWIN CITIES, INC.
Other - Org Name:HOSPICE OF THE TWIN CITIES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN LIEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-617-4671
Mailing Address - Street 1:2000 SUMMER ST NE # 100
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2648
Mailing Address - Country:US
Mailing Address - Phone:763-531-2424
Mailing Address - Fax:763-531-2422
Practice Address - Street 1:2000 SUMMER ST NE # 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2648
Practice Address - Country:US
Practice Address - Phone:763-531-2424
Practice Address - Fax:763-531-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHE0108404251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN194092900Medicaid
MN194092900Medicaid