Provider Demographics
NPI:1528450350
Name:NORTHWOODS INTERFAITH VOLUNTEER CAREGIVERS PROGRAM
Entity type:Organization
Organization Name:NORTHWOODS INTERFAITH VOLUNTEER CAREGIVERS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDI LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-333-8264
Mailing Address - Street 1:616 AMERICA AVE NW STE 110
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3853
Mailing Address - Country:US
Mailing Address - Phone:218-333-8264
Mailing Address - Fax:218-333-8263
Practice Address - Street 1:616 AMERICA AVE NW STE 110
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3853
Practice Address - Country:US
Practice Address - Phone:218-333-8264
Practice Address - Fax:218-333-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1067364-1-HCBS385H00000X
MN383337251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1528450350Medicaid
MNA246082300Medicaid