1144345067 NPI number — NORTH STAR NURSING TEMPORARY ASSOCIATES, INC.

Table of content: (NPI 1144345067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144345067 NPI number — NORTH STAR NURSING TEMPORARY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH STAR NURSING TEMPORARY ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH STAR NURSING TEMPORARY ASSOCIATES, INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144345067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22119 480TH AVE
Provider Second Line Business Mailing Address:
P.O. BOX 306
Provider Business Mailing Address City Name:
OSAGE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56570-9554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-573-2238
Provider Business Mailing Address Fax Number:
218-573-3778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22119 480TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAGE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56570-9554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-573-2238
Provider Business Practice Location Address Fax Number:
218-573-3778
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CLEMENTS
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
218-573-2238

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  333705 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 076683600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 788150000 , issued by the state of ( FM ) . This identifiers is of the category "MEDICAID".




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