Provider Demographics
NPI:1477789196
Name:H.O.M.E. PROGRAM
Entity Type:Organization
Organization Name:H.O.M.E. PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:H.O.M.E. PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KITTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-888-5530
Mailing Address - Street 1:9801 PENN AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2912
Mailing Address - Country:US
Mailing Address - Phone:952-888-5530
Mailing Address - Fax:952-881-1052
Practice Address - Street 1:9801 PENN AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2912
Practice Address - Country:US
Practice Address - Phone:952-888-5530
Practice Address - Fax:952-881-1052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIOR COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care