Provider Demographics
NPI:1114396546
Name:MOTHER TERESA HOME CARE LLC
Entity Type:Organization
Organization Name:MOTHER TERESA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FASCIL
Authorized Official - Middle Name:BIRHANU
Authorized Official - Last Name:DUBALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-978-3940
Mailing Address - Street 1:9220 BASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3000
Mailing Address - Country:US
Mailing Address - Phone:612-978-3940
Mailing Address - Fax:
Practice Address - Street 1:9220 BASS LAKE RD
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-3000
Practice Address - Country:US
Practice Address - Phone:612-978-3940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health