Provider Demographics
NPI:1255440061
Name:HOME HEALTH CARE, INCORPORATED
Entity type:Organization
Organization Name:HOME HEALTH CARE, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZINAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1763-417-8888
Mailing Address - Street 1:800 BOONE AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4468
Mailing Address - Country:US
Mailing Address - Phone:176-341-7888
Mailing Address - Fax:
Practice Address - Street 1:800 BOONE AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4468
Practice Address - Country:US
Practice Address - Phone:176-341-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331986163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN278872100Medicaid
MN278872100Medicaid