Peterson TCS LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

336384 Issued in MN

Legal business name

PETERSON TCS LLC

Doing business as

Comfort Keepers
Healthy at Home

Practice address

1205 4TH Ave S
Fargo, ND 58103-8210

Phone

(701) 237-0004

Fax

(701) 237-0029

NPI assigned

Apr 30, 2008

Organization subpart

No

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

Authorized official

Name

Joel K Peterson

Title

Owner

Phone

(701) 237-0004

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 2

• Comfort Keepers Doing business as
• Healthy at Home Doing business as

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Home health agency certification: CCN 357304

Legal name

PETERSON TCS LLC

Doing business as

HEALTHY AT HOME

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jun 6, 2017

Last certification

Jun 6, 2017

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Oct 19, 2004 in ND

Enrollment address

1205 4TH Ave S
Ste 2
Fargo, ND 58103-8210

Listed as

Healthy at HomeCCN 357304 · All quality measures

Ownership

Proprietary

Certified

Jun 6, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide, Physical therapy, Occupational therapy

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587513600000",
    "number": "1659547669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 4TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581038210",
            "telephone_number": "701-237-0004",
            "fax_number": "701-237-0029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 4TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581038210",
            "telephone_number": "701-237-0004",
            "fax_number": "701-237-0029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON TCS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-237-0004"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "336384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "994613600",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1456810",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Comfort Keepers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Healthy at Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gretchen Anne Peters, DNP, APRN, FNP-C
• Kameron Peters, D.C.
• Malea Peters, OTR/L
• Kaitlyn Janelle Petersen, OTR/L
• Nichole Petersen, LMT
• Amberlee Peterson, APRN, CNP
• Andrea B Peterson, NP
• Ashley Peterson
• Ashley Joy Peterson
• Bethany Peterson

• Home Health Agency in Fargo, ND
• Providers in Fargo, ND by specialty
• Home Health Agency in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.