Provider Demographics
NPI:1972656411
Name:ACCESS HOME CARE, LLC
Entity Type:Organization
Organization Name:ACCESS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:EMBREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-568-7662
Mailing Address - Street 1:28104 NORWAY RDG
Mailing Address - Street 2:
Mailing Address - City:PEQUOT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56472-2834
Mailing Address - Country:US
Mailing Address - Phone:218-568-7662
Mailing Address - Fax:218-568-7664
Practice Address - Street 1:28104 NORWAY RDG
Practice Address - Street 2:
Practice Address - City:PEQUOT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56472-2834
Practice Address - Country:US
Practice Address - Phone:218-568-7662
Practice Address - Fax:218-568-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332959251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59-85624OtherMEDICA PROVIDER
MN901484500Medicaid