Provider Demographics
NPI:1013082916
Name:ERICKSON COMPANIES INC.
Entity Type:Organization
Organization Name:ERICKSON COMPANIES INC.
Other - Org Name:TOWN & COUNTRY HOME HEALTH CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-872-5302
Mailing Address - Street 1:700 N MONROE ST.
Mailing Address - Street 2:BOX 117
Mailing Address - City:MINNEOTA
Mailing Address - State:MN
Mailing Address - Zip Code:56264
Mailing Address - Country:US
Mailing Address - Phone:507-872-5313
Mailing Address - Fax:507-872-5389
Practice Address - Street 1:700 NORTH MONROE STREET
Practice Address - Street 2:
Practice Address - City:MINNEOTA
Practice Address - State:MN
Practice Address - Zip Code:56264
Practice Address - Country:US
Practice Address - Phone:507-872-5313
Practice Address - Fax:507-872-5389
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERICKSON COMPANIES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-24
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02412251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN343255600Medicaid
MN8398MIOtherBCBSMN
MN123280OtherUCARE
MN343255600Medicaid