Provider Demographics
NPI:1669212056
Name:NORTHWOODS HOME CARE LLC
Entity type:Organization
Organization Name:NORTHWOODS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKAALERUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-644-9866
Mailing Address - Street 1:11253 281ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-9572
Mailing Address - Country:US
Mailing Address - Phone:612-644-9866
Mailing Address - Fax:
Practice Address - Street 1:11253 281ST AVE NW
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-9572
Practice Address - Country:US
Practice Address - Phone:612-644-9866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health