Provider Demographics
NPI:1346796182
Name:NORTHWEST HOME HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:NORTHWEST HOME HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:KOKU
Authorized Official - Last Name:AMELETSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-493-3834
Mailing Address - Street 1:1487 GOODWIN AVE. N.
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5701
Mailing Address - Country:US
Mailing Address - Phone:651-493-3834
Mailing Address - Fax:651-493-3835
Practice Address - Street 1:1821 UNIVERSITY AVE W STE S348
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2876
Practice Address - Country:US
Practice Address - Phone:651-493-3834
Practice Address - Fax:651-493-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN343G2NOOtherBLUECROSS/BLUESHIELD OF MN