Provider Demographics
NPI:1801899703
Name:NORTH CITIES HEALTH CARE, INC
Entity type:Organization
Organization Name:NORTH CITIES HEALTH CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:763-757-2320
Mailing Address - Street 1:9899 AVOCET ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-6413
Mailing Address - Country:US
Mailing Address - Phone:763-757-2320
Mailing Address - Fax:763-757-6946
Practice Address - Street 1:9899 AVOCET ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-6413
Practice Address - Country:US
Practice Address - Phone:763-757-2320
Practice Address - Fax:763-757-6946
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CITIES HEALTH CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-24
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN324795314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7100243OtherMEDICA PRIMARY
MN426040600Medicaid
MN9685PAOtherBLUE CROSS & BLUE SHIELD
MN7122589OtherMEDICA CHOICE
MNNH0263OtherUCARE
MN7122589OtherMEDICA CHOICE