Provider Demographics
NPI:1033366166
Name:MINNESOTA HOMECARE PROFESSIONALS INC.
Entity Type:Organization
Organization Name:MINNESOTA HOMECARE PROFESSIONALS INC.
Other - Org Name:MINNESOTA HOMECARE PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LYFONGE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-644-2188
Mailing Address - Street 1:PO BOX 14285
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-0285
Mailing Address - Country:US
Mailing Address - Phone:651-644-2188
Mailing Address - Fax:651-644-2198
Practice Address - Street 1:625 SNELLING AVE N
Practice Address - Street 2:SUITE 1
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4518
Practice Address - Country:US
Practice Address - Phone:651-644-2188
Practice Address - Fax:651-644-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN041427100251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN041427100Medicaid