Provider Demographics
NPI: | 1720741317 |
---|---|
Name: | ANDREWS HOME CARE SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | ANDREWS HOME CARE SERVICES, LLC |
Other - Org Name: | HOME INSTEAD |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | FRANCHISE OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ANDREWS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 218-727-8810 |
Mailing Address - Street 1: | 318 3RD AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | PROCTOR |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55810-1618 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 218-727-8810 |
Mailing Address - Fax: | 218-727-3522 |
Practice Address - Street 1: | 318 3RD AVE |
Practice Address - Street 2: | |
Practice Address - City: | PROCTOR |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55810-1618 |
Practice Address - Country: | US |
Practice Address - Phone: | 218-727-8810 |
Practice Address - Fax: | 218-727-3522 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-10-20 |
Last Update Date: | 2024-03-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 253Z00000X | Agencies | In Home Supportive Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MN | A004072000 | Medicaid |