Provider Demographics
NPI:1669772059
Name:HEALTHNORTH HOME CARE, INC.
Entity type:Organization
Organization Name:HEALTHNORTH HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-260-5280
Mailing Address - Street 1:1320 32ND AVE N
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1612
Mailing Address - Country:US
Mailing Address - Phone:320-260-5280
Mailing Address - Fax:320-281-5317
Practice Address - Street 1:1320 32ND AVE N
Practice Address - Street 2:SUITE 170
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1612
Practice Address - Country:US
Practice Address - Phone:320-260-5280
Practice Address - Fax:320-281-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHFID-32042251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHFID-32042OtherMN DEPARTMENT OF HEALTH-CLASS A NURSING LICENSE