Provider Demographics
NPI:1144345067
Name:NORTH STAR NURSING TEMPORARY ASSOCIATES, INC.
Entity type:Organization
Organization Name:NORTH STAR NURSING TEMPORARY ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:218-573-2238
Mailing Address - Street 1:22119 480TH AVE
Mailing Address - Street 2:P.O. BOX 306
Mailing Address - City:OSAGE
Mailing Address - State:MN
Mailing Address - Zip Code:56570-9554
Mailing Address - Country:US
Mailing Address - Phone:218-573-2238
Mailing Address - Fax:218-573-3778
Practice Address - Street 1:22119 480TH AVE
Practice Address - Street 2:
Practice Address - City:OSAGE
Practice Address - State:MN
Practice Address - Zip Code:56570-9554
Practice Address - Country:US
Practice Address - Phone:218-573-2238
Practice Address - Fax:218-573-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN333705251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN076683600Medicaid
FM788150000Medicaid