Provider Demographics
NPI:1457355240
Name:DYNAMIC HEALTH CONCEPTS, INC.
Entity Type:Organization
Organization Name:DYNAMIC HEALTH CONCEPTS, INC.
Other - Org Name:BIRCHWOOD CARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAGEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-823-7286
Mailing Address - Street 1:715 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2915
Mailing Address - Country:US
Mailing Address - Phone:612-823-7286
Mailing Address - Fax:612-823-0518
Practice Address - Street 1:715 W 31ST ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2915
Practice Address - Country:US
Practice Address - Phone:612-823-7286
Practice Address - Fax:612-823-0518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327466313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
24-E1966Medicare ID - Type Unspecified