Provider Demographics
NPI:1639710460
Name:DOMINION HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:DOMINION HEALTHCARE SERVICES LLC
Other - Org Name:DOMINION HEALTHCARE SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YARIA
Authorized Official - Middle Name:ISABELLA
Authorized Official - Last Name:BANGURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-812-4744
Mailing Address - Street 1:6918 GRIMES AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1450
Mailing Address - Country:US
Mailing Address - Phone:612-258-8794
Mailing Address - Fax:
Practice Address - Street 1:6918 GRIMES AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1450
Practice Address - Country:US
Practice Address - Phone:612-258-8794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health