Provider Demographics
NPI:1942603022
Name:PINES HOMECARE SERVICES LLC
Entity Type:Organization
Organization Name:PINES HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:EDMUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-724-7900
Mailing Address - Street 1:50 E SAINT MARIE ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-2634
Mailing Address - Country:US
Mailing Address - Phone:218-724-5500
Mailing Address - Fax:218-724-5535
Practice Address - Street 1:50 E SAINT MARIE ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-2634
Practice Address - Country:US
Practice Address - Phone:218-724-5500
Practice Address - Fax:218-724-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN369009251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health