Provider Demographics
NPI:1598238776
Name:U OF M HOME HEALTH LLC
Entity Type:Organization
Organization Name:U OF M HOME HEALTH LLC
Other - Org Name:GOPHER PCA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:651-206-7530
Mailing Address - Street 1:333 WASHINGTON AVE N STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1353
Mailing Address - Country:US
Mailing Address - Phone:651-206-7530
Mailing Address - Fax:651-300-8001
Practice Address - Street 1:333 WASHINGTON AVE N STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-1353
Practice Address - Country:US
Practice Address - Phone:651-206-7530
Practice Address - Fax:651-300-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health