Provider Demographics
NPI:1093051690
Name:WELCOME HOME RESIDENTIAL CARE, LLC
Entity Type:Organization
Organization Name:WELCOME HOME RESIDENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUECHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-203-8899
Mailing Address - Street 1:8466 KELL AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1502
Mailing Address - Country:US
Mailing Address - Phone:612-203-8899
Mailing Address - Fax:
Practice Address - Street 1:8466 KELL AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1502
Practice Address - Country:US
Practice Address - Phone:612-203-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN355843251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN251E00000XOtherMSHOW PRODUCT