Provider Demographics
NPI:1407534886
Name:REDEMPTION PCA SERVICES LLC
Entity Type:Organization
Organization Name:REDEMPTION PCA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMON
Authorized Official - Middle Name:DAWON
Authorized Official - Last Name:BAHTUOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-406-0577
Mailing Address - Street 1:6000 BASS LAKE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2768
Mailing Address - Country:US
Mailing Address - Phone:763-406-0577
Mailing Address - Fax:
Practice Address - Street 1:6000 BASS LAKE RD STE 120
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-2768
Practice Address - Country:US
Practice Address - Phone:763-406-0577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health