Provider Demographics
NPI:1255645974
Name:INDEPENDENT CARE AGENCY
Entity type:Organization
Organization Name:INDEPENDENT CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BINDU
Authorized Official - Middle Name:HELENA
Authorized Official - Last Name:BORBOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:763-222-9342
Mailing Address - Street 1:7420 UNITY AVE N STE 307
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443
Mailing Address - Country:US
Mailing Address - Phone:763-560-8889
Mailing Address - Fax:763-560-9097
Practice Address - Street 1:7420 UNITY AVE N STE 307
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443
Practice Address - Country:US
Practice Address - Phone:763-560-8889
Practice Address - Fax:763-560-9097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN348453251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health