Provider Demographics
NPI:1427818376
Name:HEALING HOMESTEAD
Entity type:Organization
Organization Name:HEALING HOMESTEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LIHRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-850-0944
Mailing Address - Street 1:19452 FRANCONIA TRL
Mailing Address - Street 2:
Mailing Address - City:SHAFER
Mailing Address - State:MN
Mailing Address - Zip Code:55074-9762
Mailing Address - Country:US
Mailing Address - Phone:612-850-0944
Mailing Address - Fax:
Practice Address - Street 1:19452 FRANCONIA TRL
Practice Address - Street 2:
Practice Address - City:SHAFER
Practice Address - State:MN
Practice Address - Zip Code:55074-9762
Practice Address - Country:US
Practice Address - Phone:612-850-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health