Provider Demographics
NPI:1558792234
Name:STATE WWIDE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:STATE WWIDE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-400-7667
Mailing Address - Street 1:8617 EDINBROOK XING
Mailing Address - Street 2:APT 347
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-4016
Mailing Address - Country:US
Mailing Address - Phone:763-400-7667
Mailing Address - Fax:
Practice Address - Street 1:8617 EDINBROOK XING
Practice Address - Street 2:APT 347
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-4016
Practice Address - Country:US
Practice Address - Phone:763-400-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility