Provider Demographics
NPI:1619168358
Name:DAMACARE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:DAMACARE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MAKONDE
Authorized Official - Last Name:OGATO
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, MSN, CNP
Authorized Official - Phone:651-354-6602
Mailing Address - Street 1:1359 KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4624
Mailing Address - Country:US
Mailing Address - Phone:651-354-6602
Mailing Address - Fax:
Practice Address - Street 1:1359 KNOLL DR
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4624
Practice Address - Country:US
Practice Address - Phone:651-354-6602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health