Provider Demographics
NPI:1275743874
Name:DEDICATED HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:DEDICATED HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEE
Authorized Official - Middle Name:THAO
Authorized Official - Last Name:HERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-430-8173
Mailing Address - Street 1:12122 MARQUESS LANE NORTH
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042
Mailing Address - Country:US
Mailing Address - Phone:651-430-8173
Mailing Address - Fax:651-430-8173
Practice Address - Street 1:12122 MARQUESS LN
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-4411
Practice Address - Country:US
Practice Address - Phone:651-430-8173
Practice Address - Fax:651-430-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health