Provider Demographics
NPI:1003281973
Name:HOME CARE PROFESSIONALS, INC
Entity Type:Organization
Organization Name:HOME CARE PROFESSIONALS, INC
Other - Org Name:ELMORE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LECY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-233-7565
Mailing Address - Street 1:800 BOONE AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4468
Mailing Address - Country:US
Mailing Address - Phone:763-233-7564
Mailing Address - Fax:763-417-9999
Practice Address - Street 1:800 BOONE AVE N
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4468
Practice Address - Country:US
Practice Address - Phone:763-233-7564
Practice Address - Fax:763-417-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN375331310400000X
MN375339310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN375331OtherMINNESOTA DEPARTMENT OF HEALTH - TEMPORARY COPMPREHENSIVE HOME CARE
MN375339OtherMINNESOTA DEPARTMENT OF HEALTH - TEMPORARY COPMPREHENSIVE HOME CARE