Provider Demographics
NPI:1083818496
Name:WICARE SERVICES LLC
Entity Type:Organization
Organization Name:WICARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAMEINO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:952-564-0631
Mailing Address - Street 1:10640 JUNIPER ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-6511
Mailing Address - Country:US
Mailing Address - Phone:952-564-0631
Mailing Address - Fax:952-881-0630
Practice Address - Street 1:10640 JUNIPER ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-6511
Practice Address - Country:US
Practice Address - Phone:952-564-0631
Practice Address - Fax:952-881-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health