Provider Demographics
NPI:1043866015
Name:DAKOTA PREMIER HOME CARE
Entity Type:Organization
Organization Name:DAKOTA PREMIER HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:KORKOR
Authorized Official - Last Name:GARNETT-MOMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-390-0168
Mailing Address - Street 1:2108 EASTBAY DR SE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-6271
Mailing Address - Country:US
Mailing Address - Phone:646-427-6612
Mailing Address - Fax:
Practice Address - Street 1:2108 EASTBAY DR SE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-6271
Practice Address - Country:US
Practice Address - Phone:646-427-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health