Provider Demographics
NPI:1689797102
Name:ACUTE HOME HEALTH CARE OF MN
Entity Type:Organization
Organization Name:ACUTE HOME HEALTH CARE OF MN
Other - Org Name:TRANQUIL LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMLOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHN
Authorized Official - Phone:952-361-0080
Mailing Address - Street 1:6385 OLD SHADY OAK RD
Mailing Address - Street 2:STE 250
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3299
Mailing Address - Country:US
Mailing Address - Phone:952-361-0080
Mailing Address - Fax:952-448-1996
Practice Address - Street 1:6385 OLD SHADY OAK RD STE 250
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7705
Practice Address - Country:US
Practice Address - Phone:952-361-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251E00000X
MN1039688-2-AFC311ZA0620X
MN1039690-2-AFC311ZA0620X, 311ZA0620X
MN34050311ZA0620X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN34050OtherMN- CODE 18 FOR HOME AND COMMUNITY BASED SERVICES
MN242275100OtherMN-CODE 18 FOR HOME AND COMMUNITY BASED SERVICES
MN387817OtherCOMPREHENSIVE HOME CARE