Provider Demographics
NPI:1275084469
Name:LOYALTY HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:LOYALTY HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIBUZO
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-537-9199
Mailing Address - Street 1:5747 W BROADWAY AVE STE 212B
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3549
Mailing Address - Country:US
Mailing Address - Phone:763-537-9199
Mailing Address - Fax:763-537-9199
Practice Address - Street 1:5747 W BROADWAY AVE STE 212B
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3549
Practice Address - Country:US
Practice Address - Phone:763-537-9199
Practice Address - Fax:763-537-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN378961251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health