Interim Healthcare of Lake Superior, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

INTERIM HEALTHCARE OF LAKE SUPERIOR, INC.

Practice address

332 W Superior St
Suite 204
Duluth, MN 55802

Phone

(218) 722-0053

Fax

(218) 722-0318

NPI assigned

May 31, 2005

Organization subpart

No

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

Authorized official

Name

Kari Jo Jarvi

Title

Controller

Phone

(218) 722-0053

Specialties & licenses 2

Addresses

Other identifiers 6

Locations

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570492800000",
    "number": "1417950874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 W SUPERIOR ST",
            "address_2": "SUITE 204",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55802",
            "telephone_number": "218-722-0053",
            "fax_number": "218-722-0318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 W SUPERIOR ST",
            "address_2": "SUITE 204",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55802",
            "telephone_number": "218-722-0053",
            "fax_number": "218-722-0318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERIM HEALTHCARE OF LAKE SUPERIOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2019-10-08",
        "status": "A",
        "authorized_official_last_name": "JARVI",
        "authorized_official_first_name": "KARI",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "218-722-0053"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "327241",
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "109638",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41529800",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "96435590",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8569IN",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "964355900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "59-00052",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2019; 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.