Basic Information
| Provider Information | |||||||||
| NPI: | 1255363438 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CUYUNA REGIONAL MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CUYUNA REGIONAL MEDICAL CENTER HOME HEALTH, PALLIATIVE AND HOSPICE CAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 HEARTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CROSBY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564415601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2185467000 | ||||||||
| FaxNumber: | 2185464645 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 HEARTWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CROSBY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564415601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2185467000 | ||||||||
| FaxNumber: | 2185464645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 11/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | BERG | ||||||||
| AuthorizedOfficialFirstName: | KATIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2185467000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 329842 | MN | N | Agencies | Hospice Care, Community Based | 251E00000X | 329842 | MN | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 1598ACU | 01 | MN | BCBS HOMECARE | OTHER | 124184 | 01 | MN | UCARE HOMECARE | OTHER | 247171 | 01 | MN | MEDICARE HOME CARE | OTHER | 5025389 | 01 | MN | MEDICA CHOICE | OTHER | 241537 | 01 | MN | MEDICARE HOSPICE | OTHER | 5000069 | 01 | MN | MEDICA PRIMARY | OTHER | 5900048 | 01 | MN | MEDICA HOMECARE | OTHER | 01012762 | 01 | MN | PREFERRED ONE HOMECARE | OTHER | 1598ACU | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER |