Organization
PROVISIONAL HOME HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTINE ANN CARR RN (DIRECTOR OF NURSING)
(763) 575-7281
Entity
Organization
Contact information
Practice address
4110 MAPLE HURST DR S, ROCKFORD, MN 55373-4565
(763) 575-7281
Mailing address
4110 MAPLE HURST DR S, ROCKFORD, MN 55373-4565
(763) 575-7281
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
353499
MN
Other
Enumeration date
07/21/2011
Last updated
07/21/2011
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