Provider Demographics
NPI:1346713682
Name:PRISENDORF CARE, LLC
Entity Type:Organization
Organization Name:PRISENDORF CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-756-9220
Mailing Address - Street 1:3131 FERNBROOK LN N STE 105
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5336
Mailing Address - Country:US
Mailing Address - Phone:763-432-5095
Mailing Address - Fax:
Practice Address - Street 1:3131 FERNBROOK LN N STE 105
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5336
Practice Address - Country:US
Practice Address - Phone:763-432-5095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health