Provider Demographics
NPI:1801295399
Name:HHC SERVICES MN, INC
Entity type:Organization
Organization Name:HHC SERVICES MN, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILLELAND
Authorized Official - Suffix:
Authorized Official - Credentials:CSA, CBIS
Authorized Official - Phone:701-850-2000
Mailing Address - Street 1:4302 13TH AVE S
Mailing Address - Street 2:SUITE 4-375
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3395
Mailing Address - Country:US
Mailing Address - Phone:701-850-2000
Mailing Address - Fax:
Practice Address - Street 1:3227 OAK RIDGE LOOP E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8482
Practice Address - Country:US
Practice Address - Phone:701-850-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNAPPLIED FOR251E00000X
ND1464610251G00000X, 251J00000X, 253Z00000X, 251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1464610Medicaid