Provider Demographics
NPI:1659916393
Name:NKOYO NYONG-BASSEY & FUNMILAYO OKOYA LLC
Entity Type:Organization
Organization Name:NKOYO NYONG-BASSEY & FUNMILAYO OKOYA LLC
Other - Org Name:IMPACT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NKOYO
Authorized Official - Middle Name:
Authorized Official - Last Name:NYONG-BASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-201-1220
Mailing Address - Street 1:4844 MADISON ST NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2332
Mailing Address - Country:US
Mailing Address - Phone:952-201-1220
Mailing Address - Fax:
Practice Address - Street 1:860 BLUE GENTIAN RD STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1567
Practice Address - Country:US
Practice Address - Phone:952-201-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care