Provider Demographics
NPI:1497995203
Name:KINDER CARE HOMECARE SERVICES
Entity Type:Organization
Organization Name:KINDER CARE HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:MOGUSERO
Authorized Official - Last Name:MORANDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-472-4635
Mailing Address - Street 1:270 COUNTY ROAD 110 N
Mailing Address - Street 2:
Mailing Address - City:MINNETRISTA
Mailing Address - State:MN
Mailing Address - Zip Code:55364-8316
Mailing Address - Country:US
Mailing Address - Phone:952-472-4635
Mailing Address - Fax:
Practice Address - Street 1:270 COUNTY ROAD 110 N
Practice Address - Street 2:
Practice Address - City:MINNETRISTA
Practice Address - State:MN
Practice Address - Zip Code:55364-8316
Practice Address - Country:US
Practice Address - Phone:952-472-4635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25296313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility