Provider Demographics
NPI:1558707190
Name:MANKATO HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:MANKATO HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:ADAN
Authorized Official - Last Name:IBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-774-3622
Mailing Address - Street 1:3400 1ST ST N STE 402
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1928
Mailing Address - Country:US
Mailing Address - Phone:773-664-2385
Mailing Address - Fax:320-774-1251
Practice Address - Street 1:3400 1ST ST N STE 402
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1928
Practice Address - Country:US
Practice Address - Phone:773-664-2385
Practice Address - Fax:320-774-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health