Provider Demographics
NPI:1811422686
Name:SPECIALIZED HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:SPECIALIZED HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-398-1728
Mailing Address - Street 1:848 ASPEN CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1003
Mailing Address - Country:US
Mailing Address - Phone:651-398-1728
Mailing Address - Fax:651-436-2349
Practice Address - Street 1:848 ASPEN CIR
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55109-1003
Practice Address - Country:US
Practice Address - Phone:651-398-1728
Practice Address - Fax:651-436-2349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA741158800251E00000X
MNA247448300251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherHOME HEALTH CARE AGENCY