Hermantown Valley Elder Care

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

1031815-4-AFC Issued in MN

Legal business name

HERMANTOWN VALLEY ELDER CARE

Practice address

5140 Wagner Rd
Hermantown, MN 55810-2543

Phone

(218) 729-9831

NPI assigned

Sep 24, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Timothy Russell Majchrzak Sr.

Title

Owner

Phone

(218) 729-9831

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253750400000",
    "number": "1104150044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 WAGNER RD",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558102543",
            "telephone_number": "218-729-9831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5140 WAGNER RD",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558102543",
            "telephone_number": "218-729-9831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERMANTOWN VALLEY ELDER CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-24",
        "last_updated": "2009-09-24",
        "status": "A",
        "authorized_official_last_name": "MAJCHRZAK",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-729-9831",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MN",
            "license": "1031815-4-AFC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "4980573",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Hermantown, MN
• Providers in Hermantown, MN by specialty
• Exclusive Provider Organization in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.