1194122747 NPI number — ACCURATE HOME CARE OF NORTH DAKOTA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194122747 NPI number — ACCURATE HOME CARE OF NORTH DAKOTA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCURATE HOME CARE OF NORTH DAKOTA, LLC
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:
Provider Other Organization Name Type Code:
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:
1194122747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9000 QUANTRELLE AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTSEGO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-633-3800
Provider Business Mailing Address Fax Number:
763-633-3808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 28TH ST. S STE A
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-232-1245
Provider Business Practice Location Address Fax Number:
701-232-0813
Provider Enumeration Date:
11/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LUNDSTROM
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
763-633-3800

Provider Taxonomy Codes

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

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





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