Provider Demographics
NPI:1942203864
Name:PENNINGTON & RED LAKE COUNTY PUBLIC HEALTH & HOME CARE
Entity Type:Organization
Organization Name:PENNINGTON & RED LAKE COUNTY PUBLIC HEALTH & HOME CARE
Other - Org Name:INTER-COUNTY NURSING SERVICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHN
Authorized Official - Phone:218-681-0876
Mailing Address - Street 1:101 MAIN AVE N
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-1901
Mailing Address - Country:US
Mailing Address - Phone:218-681-0876
Mailing Address - Fax:218-683-7099
Practice Address - Street 1:101 MAIN AVE N
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-1901
Practice Address - Country:US
Practice Address - Phone:218-681-0876
Practice Address - Fax:218-683-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN326512251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN458554200Medicaid
MN1045280OtherPREFERRED ONE
MN8227INOtherBCBS OF MN/BLUE PLUS
MN167895OtherUCARE WITH ALTRU
MN167897OtherUCARE WITH ALTRU
MN8G493INOtherBCBS OF MN/BLUE PLUS
MN458554200Medicaid
MN8227INOtherBCBS OF MN/BLUE PLUS