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
State | License ID | Taxonomies |
---|---|---|
MN | R148311-8 | 311ZA0620X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |