Provider Demographics
NPI:1598300048
Name:CITY OF LAKES HOME CARE LLC
Entity Type:Organization
Organization Name:CITY OF LAKES HOME CARE LLC
Other - Org Name:CITY OF LAKES HOME CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:HODAN
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:SALAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-398-5667
Mailing Address - Street 1:393 N DUNLAP ST SUITE 450H
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4238
Mailing Address - Country:US
Mailing Address - Phone:573-355-0177
Mailing Address - Fax:651-528-8346
Practice Address - Street 1:393 N DUNLAP ST SUITE 450H
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4238
Practice Address - Country:US
Practice Address - Phone:573-355-0177
Practice Address - Fax:651-528-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health