1619978269 NPI number — COMFORT HOME HEALTH CARE GROUP, INC.

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 1619978269 NPI number — COMFORT HOME HEALTH CARE GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMFORT HOME HEALTH CARE GROUP, 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:
Provider Other Organization Name Type Code:
6
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:
1619978269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2746 SUPERIOR DR NW
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55901-8343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-281-2332
Provider Business Mailing Address Fax Number:
507-281-2632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2746 SUPERIOR DR NW
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55901-8343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-281-2332
Provider Business Practice Location Address Fax Number:
507-281-2632
Provider Enumeration Date:
08/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLUM
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
507-281-2332

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  HFID-21496 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 02238 , 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: 471856900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8354CO . This is a "BLUE CROSS BLUE SHIELD PR" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 173586 . This is a "U CARE PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5900245 . This is a "MEDICA PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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