Provider Demographics
NPI:1548574403
Name:COMPLETE HOME HEALTH SERVICES PCA
Entity Type:Organization
Organization Name:COMPLETE HOME HEALTH SERVICES PCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRRI
Authorized Official - Middle Name:ATANG
Authorized Official - Last Name:NOMO-ONGOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD; PHD
Authorized Official - Phone:612-788-2273
Mailing Address - Street 1:3616 ROOSEVELT ST NE
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-1559
Mailing Address - Country:US
Mailing Address - Phone:612-788-2273
Mailing Address - Fax:612-886-1939
Practice Address - Street 1:4001 STINSON BLVD
Practice Address - Street 2:SUITE LL32
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-3488
Practice Address - Country:US
Practice Address - Phone:612-788-2273
Practice Address - Fax:612-886-1939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPLETE HOME HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health