Provider Demographics
NPI:1942440441
Name:CENTRAL MINNESOTA HOME CARE, INC.
Entity Type:Organization
Organization Name:CENTRAL MINNESOTA HOME CARE, INC.
Other - Org Name:PREFERRED CARE AT HOME OF CENTRAL MINNESOTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LIVINGSTON
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-546-5000
Mailing Address - Street 1:22413 STATE HIGHWAY 6
Mailing Address - Street 2:200
Mailing Address - City:DEERWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56444-6245
Mailing Address - Country:US
Mailing Address - Phone:218-546-5000
Mailing Address - Fax:218-546-5033
Practice Address - Street 1:22413 STATE HIGHWAY 6
Practice Address - Street 2:200
Practice Address - City:DEERWOOD
Practice Address - State:MN
Practice Address - Zip Code:56444-6245
Practice Address - Country:US
Practice Address - Phone:218-546-5000
Practice Address - Fax:218-546-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN342906251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care