Provider Demographics
NPI:1083891097
Name:SOUTH METRO CARE SERVICES
Entity Type:Organization
Organization Name:SOUTH METRO CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:MORONGE
Authorized Official - Last Name:MOGAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-423-6619
Mailing Address - Street 1:17873 FLORAL PARK CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6042
Mailing Address - Country:US
Mailing Address - Phone:612-423-6619
Mailing Address - Fax:
Practice Address - Street 1:17873 FLORAL PARK CIR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6042
Practice Address - Country:US
Practice Address - Phone:612-423-6619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN338790163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty