Provider Demographics
NPI:1215916903
Name:FAIRVIEW HOME CARE AND HOSPICE
Entity type:Organization
Organization Name:FAIRVIEW HOME CARE AND HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALVORSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-728-2340
Mailing Address - Street 1:2450 26TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1245
Mailing Address - Country:US
Mailing Address - Phone:612-728-2350
Mailing Address - Fax:612-728-2400
Practice Address - Street 1:2450 26TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1245
Practice Address - Country:US
Practice Address - Phone:612-728-2350
Practice Address - Fax:612-728-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328944251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN102058OtherUCARE
MN5900124OtherHOMECARE WITH MEDICA
MN650OtherPREFERRED ONE
MN112648OtherKVI CHOICE PLUS
MN680OtherHEALTHPARTNERS
MNHHC1201OtherARAZ (AMERICA'S PPO)
MN473555200Medicaid
MN8284HOOtherHOMECARE WITH BLUE CROSS
MN=========003OtherTRICARE