Provider Demographics
NPI:1548737547
Name:MY NURSES CARE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:MY NURSES CARE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MELCHIZEDEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-291-5198
Mailing Address - Street 1:4355 KADY AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-8498
Mailing Address - Country:US
Mailing Address - Phone:763-291-5198
Mailing Address - Fax:
Practice Address - Street 1:4355 KADY AVE NE
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-8498
Practice Address - Country:US
Practice Address - Phone:763-291-5198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-28
Last Update Date:2018-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN384924OtherCOMPREHENSIVE HOME CARE LICENSE