Mahube-Otwa Community Action Partnership
Organization Active NPI In Home Supportive Care Agency · Detroit Lakes, MN
NPI 1285910596 · NPPES record last updated May 7, 2019
Key facts
- NPI
- 1285910596
- Entity type
- Organization (NPI type 2)
- Primary specialty
- In Home Supportive Care Agency 253Z00000X
- License
- A246932400 (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
- Organization subpart
- No
Authorized official
- Name
- Elizabeth Kuoppala
- Title
- Executive Director
- Phone
- (218) 847-1385
Practitioners 11
-
Marna M Crow, CNM
-
Ceree E. George, CNM
-
Paige W Hardy, CNM
-
Cynthia Kay Rastedt, RN, BSN
-
Courtney Rohloff, APRN, CNP
-
Amy L Severson, NP
-
Linda Rae Vanroekel Kuismi, RNC/FNP
-
June N Zimmerman, RN,CNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0856659 | Mahube-Otwa Community Action Partnership, Inc | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
Locations
1125 W River Rd
Detroit Lakes, MN 56501
Phone (218) 844-5832
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| In Home Supportive Care Agency | 253Z00000X | A246932400 | MN | Yes |
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
Other providers in Detroit Lakes, MN
- Lutheran Social Service of Minnesota
- Trey William Lyngaas
- Peggy J Maasjo
- Darren Garold Mack
- Kelli Marie Mack
- Mahube-Otwa Community Action Partnership
- Vinh Mai
- Ryan Richard Manke
- Olivia I Mann
- Amy Marchus
All providers in Detroit Lakes, MN · In Home Supportive Care Agency in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.