Organization
FAIRVIEW HOME CARE AND HOSPICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA HALVORSON (PRESIDENT)
(612) 728-2340
Entity
Organization
Contact information
Practice address
2450 26TH AVE S, MINNEAPOLIS, MN 55406-9854
(612) 728-2350
(612) 728-2400
Mailing address
2450 26TH AVE S, MINNEAPOLIS, MN 55406-9854
(612) 728-2350
(612) 728-2400
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
329541
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
241514
MEDICARE PROVIDER NUMBER
MN
01
—
6012484
MEDICA
MN
05
—
624555200
—
MN
Enumeration date
01/12/2006
Last updated
09/26/2018
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