Basic Information
| Provider Information | |||||||||
| NPI: | 1942603022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINES HOMECARE SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 E SAINT MARIE ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558032634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187245500 | ||||||||
| FaxNumber: | 2187245535 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 E SAINT MARIE ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558032634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187245500 | ||||||||
| FaxNumber: | 2187245535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2014 | ||||||||
| LastUpdateDate: | 10/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | EDMUNDS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2187247900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 369009 | MN | Y | Agencies | Home Health |
No ID Information.