Provider Demographics
NPI:1629204854
Name:ULTRA CARE HOME HEALTH LLC
Entity Type:Organization
Organization Name:ULTRA CARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:OKECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-493-8620
Mailing Address - Street 1:1867 DELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6103
Mailing Address - Country:US
Mailing Address - Phone:651-493-8620
Mailing Address - Fax:651-493-8620
Practice Address - Street 1:1867 DELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6103
Practice Address - Country:US
Practice Address - Phone:651-493-8620
Practice Address - Fax:651-493-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343855251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health