NPI 1104150044

Hermantown Valley Elder Care

Organisation Exclusive Provider Organization Hermantown, MN

Practice location

Address: 5140 Wagner Rd, Hermantown, MN 55810-2543
Phone: (218) 729-9831

Authorised official

Name: Timothy Russell Majchrzak
Title: Owner
Phone: (218) 729-9831

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 1031815-4-AFC (MN)

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Registry record

NPI: 1104150044
Entity type: Organization
NPI issued: 24 Sep 2009
Record last updated: 24 Sep 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.