Organization
HERMANTOWN VALLEY ELDER CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY RUSSELL MAJCHRZAK SR. (OWNER)
(218) 729-9831
Entity
Organization
Contact information
Practice address
5140 WAGNER RD, HERMANTOWN, MN 55810-2543
(218) 729-9831
Mailing address
5140 WAGNER RD, HERMANTOWN, MN 55810-2543
(218) 729-9831
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
1031815-4-AFC
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4980573
MEDICA
MN
Enumeration date
09/24/2009
Last updated
09/24/2009
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