Provider Demographics
NPI:1942602081
Name:UNITED HOME CARE INC
Entity Type:Organization
Organization Name:UNITED HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-587-8920
Mailing Address - Street 1:7748 FLORIDA CIR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2724
Mailing Address - Country:US
Mailing Address - Phone:763-587-8920
Mailing Address - Fax:612-521-9917
Practice Address - Street 1:7748 FLORIDA CIR N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2724
Practice Address - Country:US
Practice Address - Phone:763-587-8920
Practice Address - Fax:612-521-9917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN383938451302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN383938451Medicaid
MN383938451Medicare UPIN