Provider Demographics
NPI:1205145471
Name:SOUTHERN MINNESOTA CARE, LLC
Entity type:Organization
Organization Name:SOUTHERN MINNESOTA CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:REZAC
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:507-402-0433
Mailing Address - Street 1:216 E MAIN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-2919
Mailing Address - Country:US
Mailing Address - Phone:507-373-4300
Mailing Address - Fax:507-373-4304
Practice Address - Street 1:216 E MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2919
Practice Address - Country:US
Practice Address - Phone:507-373-4300
Practice Address - Fax:507-373-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN349468251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health