Provider Demographics
NPI:1013296748
Name:DEEP HARMONY HOME CARE LLC
Entity type:Organization
Organization Name:DEEP HARMONY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ROSETTA
Authorized Official - Last Name:CASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN,
Authorized Official - Phone:651-459-2981
Mailing Address - Street 1:7111 TIMBER TRAIL LN S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4772
Mailing Address - Country:US
Mailing Address - Phone:651-459-2981
Mailing Address - Fax:
Practice Address - Street 1:7299 97TH ST S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-3880
Practice Address - Country:US
Practice Address - Phone:651-459-2981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR148311-8311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home