Provider Demographics
NPI:1558091140
Name:ST RAPHAELS HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:ST RAPHAELS HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RN
Authorized Official - Prefix:
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POCTA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-358-0489
Mailing Address - Street 1:6555 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-5744
Mailing Address - Country:US
Mailing Address - Phone:612-358-0489
Mailing Address - Fax:
Practice Address - Street 1:6555 MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-5744
Practice Address - Country:US
Practice Address - Phone:612-358-0489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty