Provider Demographics
NPI:1871247585
Name:MINNESOTA HOME CARE PROVIDER INC.
Entity Type:Organization
Organization Name:MINNESOTA HOME CARE PROVIDER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PA NYIA
Authorized Official - Middle Name:X
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-337-5711
Mailing Address - Street 1:1088 RICE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2907
Mailing Address - Country:US
Mailing Address - Phone:651-337-5711
Mailing Address - Fax:651-202-3965
Practice Address - Street 1:1088 RICE ST STE 1
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2907
Practice Address - Country:US
Practice Address - Phone:651-337-5711
Practice Address - Fax:651-202-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA614442600OtherHOME CARE ANAGECY