NPIMap

Organization Active NPI

Mahube-Otwa Community Action Partnership

  • In Home Supportive Care Agency
  • Detroit Lakes, MN
National Provider Identifier
1285910596
Registry record updated May 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
A246932400 Issued in MN
Legal business name
MAHUBE-OTWA COMMUNITY ACTION PARTNERSHIP
Practice address
1125 W River Rd
Detroit Lakes, MN 56501-2722
Phone
(218) 847-1385
Fax
(218) 847-1388
NPI assigned
Nov 1, 2011
Last updated
May 7, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2019

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

Authorized official

Name
Elizabeth Kuoppala
Title
Executive Director
Phone
(218) 847-1385

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X A246932400 MN Primary

Addresses

Primary practice location

1125 W River Rd
Detroit Lakes, MN 56501-2722

Mailing address

PO Box 747
Detroit Lakes, MN 56502-0747
Phone (218) 847-1385

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0856659Mahube-Otwa Community Action Partnership, Inc1125 West River Road, Detroit Lakes, MN 56501Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1320105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557187200000",
    "number": "1285910596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 747",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565020747",
            "telephone_number": "218-847-1385",
            "fax_number": "218-847-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 W RIVER RD",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012722",
            "telephone_number": "218-847-1385",
            "fax_number": "218-847-1388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHUBE-OTWA COMMUNITY ACTION PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-01",
        "last_updated": "2019-05-07",
        "status": "A",
        "authorized_official_last_name": "KUOPPALA",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "218-847-1385"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MN",
            "license": "A246932400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit Lakes, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.