Provider Demographics
NPI:1235360637
Name:WICARE HOMECARE SERVICES
Entity Type:Organization
Organization Name:WICARE HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:MBABAZI
Authorized Official - Last Name:MICHORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-738-4890
Mailing Address - Street 1:1885 UNIVERSITY AVE W STE 300B
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3462
Mailing Address - Country:US
Mailing Address - Phone:651-738-4890
Mailing Address - Fax:651-846-6530
Practice Address - Street 1:1885 UNIVERSITY AVE W SUIT#300B
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-738-4890
Practice Address - Fax:651-846-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343327251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA760018300OtherSTRAIGHT MEDICARE(MA)
MNA156483100OtherSTRAIGHT MEDICARE