Provider Demographics
NPI:1023302841
Name:GOLDEN VALLEY HOME CARE
Entity type:Organization
Organization Name:GOLDEN VALLEY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHUKRI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-353-7728
Mailing Address - Street 1:4725 OLSON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5143
Mailing Address - Country:US
Mailing Address - Phone:612-353-7728
Mailing Address - Fax:612-822-2998
Practice Address - Street 1:4725 OLSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-5143
Practice Address - Country:US
Practice Address - Phone:612-353-7728
Practice Address - Fax:612-822-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based