Provider Demographics
NPI:1922628825
Name:FANTUM HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:FANTUM HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:ISAWUMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-251-4521
Mailing Address - Street 1:3417 98TH CIR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1867
Mailing Address - Country:US
Mailing Address - Phone:612-251-4521
Mailing Address - Fax:763-432-3375
Practice Address - Street 1:8032 FRANCE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2811
Practice Address - Country:US
Practice Address - Phone:612-251-4521
Practice Address - Fax:763-432-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health