Provider Demographics
NPI:1285737460
Name:INTERIM HEALTHCARE OF THE TWIN CITIES, INC
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF THE TWIN CITIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:GEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-917-3634
Mailing Address - Street 1:2200 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1839
Mailing Address - Country:US
Mailing Address - Phone:651-917-3634
Mailing Address - Fax:651-917-3620
Practice Address - Street 1:2200 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1839
Practice Address - Country:US
Practice Address - Phone:651-917-3634
Practice Address - Fax:651-917-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331118251E00000X
MN332058251E00000X
MN331122251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59-80004OtherMEDICA PROVIDER NUMBER
MN2C44INOtherBLUE CROSS PROVIDER NUMBE
MN358600600Medicaid
MN102986OtherUCARE PROVIDER NUMBER
MN79231OtherHEALTHPARTNERS PROVIDER N
MN358600600Medicaid