Provider Demographics
NPI:1992811434
Name:MINNEWASKA HOME CARE INC
Entity type:Organization
Organization Name:MINNEWASKA HOME CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:KNOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-239-7104
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:605 MAIN STREET
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381-0040
Mailing Address - Country:US
Mailing Address - Phone:320-239-7259
Mailing Address - Fax:320-239-7263
Practice Address - Street 1:605 MAIN STREET
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381-0040
Practice Address - Country:US
Practice Address - Phone:320-239-7259
Practice Address - Fax:320-239-7263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN03853251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN633621300Medicaid
MN633621300Medicaid