Provider Demographics
NPI:1568101467
Name:PURPLE VINE HOME CARE
Entity Type:Organization
Organization Name:PURPLE VINE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ASSISTED LIVING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KAPILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-227-8846
Mailing Address - Street 1:13888 88TH ST NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-0079
Mailing Address - Country:US
Mailing Address - Phone:763-227-8846
Mailing Address - Fax:763-592-8085
Practice Address - Street 1:3018 THURBER RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1858
Practice Address - Country:US
Practice Address - Phone:763-227-8846
Practice Address - Fax:763-592-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1851953343OtherGROUP HOME