Provider Demographics
NPI:1184244527
Name:KAM HOMECARE
Entity type:Organization
Organization Name:KAM HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANNEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-709-3880
Mailing Address - Street 1:1500 NICOLLET AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2724
Mailing Address - Country:US
Mailing Address - Phone:612-709-3880
Mailing Address - Fax:
Practice Address - Street 1:1500 NICOLLET AVE APT 305
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2724
Practice Address - Country:US
Practice Address - Phone:612-709-3880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities