Provider Demographics
NPI:1578298758
Name:STURDYCARE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:STURDYCARE HEALTH SERVICES LLC
Other - Org Name:STURDYCARE HEALTH SERVICES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERAPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-300-0048
Mailing Address - Street 1:24247 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-3106
Mailing Address - Country:US
Mailing Address - Phone:763-300-0048
Mailing Address - Fax:
Practice Address - Street 1:24247 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-3106
Practice Address - Country:US
Practice Address - Phone:763-300-0048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN413283OtherLICENSE NUMBER
MN406339OtherLICENSE NUMBER