Provider Demographics
NPI:1477283026
Name:IMED HOME CARE LLC
Entity Type:Organization
Organization Name:IMED HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:MORONGE
Authorized Official - Last Name:MOGAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-730-4235
Mailing Address - Street 1:10800 LYNDALE AVE S STE 150
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-5698
Mailing Address - Country:US
Mailing Address - Phone:612-730-4235
Mailing Address - Fax:
Practice Address - Street 1:4309 W OLD SHAKOPEE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-2952
Practice Address - Country:US
Practice Address - Phone:612-730-4235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility