Provider Demographics
NPI:1629141213
Name:PEDIATRIC HOME RESPIRATORY SERVICES LLC
Entity Type:Organization
Organization Name:PEDIATRIC HOME RESPIRATORY SERVICES LLC
Other - Org Name:PEDIATRIC HOME SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAMEO
Authorized Official - Middle Name:KAE
Authorized Official - Last Name:ZEHNDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-642-1825
Mailing Address - Street 1:2800 CLEVELAND AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1126
Mailing Address - Country:US
Mailing Address - Phone:651-642-1825
Mailing Address - Fax:651-638-0690
Practice Address - Street 1:2800 CLEVELAND AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1126
Practice Address - Country:US
Practice Address - Phone:651-642-1825
Practice Address - Fax:651-638-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN239L7PEOtherBCBS-MN
MN242121600Medicaid
WI100085688Medicaid