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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:763-746-8060
Mailing Address - Street 1:10300 10TH AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-4925
Mailing Address - Country:US
Mailing Address - Phone:763-746-8060
Mailing Address - Fax:763-746-8063
Practice Address - Street 1:10300 10TH AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-4925
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:2013-02-15
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
870000829OtherHUMANA
MN164398OtherUCARE
MN234933100Medicaid
87361OtherHEALTH PARTNERS
1031834OtherPREFERRED ONE
MN4605640OtherBCBS OF MN
8300115OtherMEDICA
8300115OtherMEDICA
870000829OtherHUMANA
=========OtherSTERLING LIFE INS CO
MN164398OtherUCARE
=========OtherUNITED HEALTHCARE
=========OtherREGENCE BCBS OF OREGON
=========OtherUNICARE
1031834OtherPREFERRED ONE
87361OtherHEALTH PARTNERS