Provider Demographics
NPI:1508015504
Name:REMEDIOS HOME HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:REMEDIOS HOME HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:ONTIVEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-244-7334
Mailing Address - Street 1:41949 RICE LAKE RD NE
Mailing Address - Street 2:
Mailing Address - City:BRAHAM
Mailing Address - State:MN
Mailing Address - Zip Code:55006-3117
Mailing Address - Country:US
Mailing Address - Phone:763-244-7334
Mailing Address - Fax:866-605-0893
Practice Address - Street 1:41949 RICE LAKE RD NE
Practice Address - Street 2:
Practice Address - City:BRAHAM
Practice Address - State:MN
Practice Address - Zip Code:55006-3117
Practice Address - Country:US
Practice Address - Phone:763-244-7334
Practice Address - Fax:866-605-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN341818251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health