Provider Demographics
NPI:1992818231
Name:HOMELAND HEALTH SPECIALISTS INC
Entity type:Organization
Organization Name:HOMELAND HEALTH SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WISTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-894-0774
Mailing Address - Street 1:1621 E HENNEPIN AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2489
Mailing Address - Country:US
Mailing Address - Phone:763-746-8060
Mailing Address - Fax:763-746-8063
Practice Address - Street 1:1621 E HENNEPIN AVE STE 230
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2489
Practice Address - Country:US
Practice Address - Phone:763-746-8060
Practice Address - Fax:763-746-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR121223-7163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN164398OtherUCARE
8300115OtherMEDICA
MN234933100Medicaid
MN4605640OtherBCBS OF MN
87361OtherHEALTH PARTNERS
1031834OtherPREFERRED ONE
870000829OtherHUMANA
8300115OtherMEDICA
870000829OtherHUMANA
=========OtherSTERLING LIFE INS CO
MN164398OtherUCARE
=========OtherUNITED HEALTHCARE
=========OtherREGENCE BCBS OF OREGON
=========OtherUNICARE
1031834OtherPREFERRED ONE
87361OtherHEALTH PARTNERS