Provider Demographics
NPI:1275523953
Name:HENNEPIN HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:HENNEPIN HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-425-5959
Mailing Address - Street 1:8590 EDINBURGH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3723
Mailing Address - Country:US
Mailing Address - Phone:763-425-5959
Mailing Address - Fax:763-425-5929
Practice Address - Street 1:8590 EDINBURGH CENTER DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3723
Practice Address - Country:US
Practice Address - Phone:763-425-5959
Practice Address - Fax:763-425-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328275251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN485717800Medicaid
MN247001Medicare ID - Type Unspecified