Provider Demographics
NPI:1265510499
Name:MAYFAIR HOME MEDICAL
Entity Type:Organization
Organization Name:MAYFAIR HOME MEDICAL
Other - Org Name:MAYFAIR HOME HEALTH SERVICES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSEMEKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-746-4571
Mailing Address - Street 1:1710 DOUGLAS DR N
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4327
Mailing Address - Country:US
Mailing Address - Phone:952-746-4570
Mailing Address - Fax:952-746-4573
Practice Address - Street 1:1710 DOUGLAS DR N
Practice Address - Street 2:SUITE # 104
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4327
Practice Address - Country:US
Practice Address - Phone:952-746-4570
Practice Address - Fax:952-746-4573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN460216332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies