Provider Demographics
NPI:1912549742
Name:HIS SERVICES HOME CARE, LLC
Entity Type:Organization
Organization Name:HIS SERVICES HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:ALETOR
Authorized Official - Last Name:ONAIWU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:763-321-0541
Mailing Address - Street 1:2108 70TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1003
Mailing Address - Country:US
Mailing Address - Phone:763-321-0541
Mailing Address - Fax:763-566-4130
Practice Address - Street 1:2108 70TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55430
Practice Address - Country:US
Practice Address - Phone:763-321-0541
Practice Address - Fax:763-566-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health