Provider Demographics
NPI:1255665071
Name:MISSY HOME CARE SERVICES, LLC
Entity type:Organization
Organization Name:MISSY HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MODOU
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-303-3561
Mailing Address - Street 1:750 2ND ST NE
Mailing Address - Street 2:SUITE 138
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8587
Mailing Address - Country:US
Mailing Address - Phone:952-303-3561
Mailing Address - Fax:952-303-3562
Practice Address - Street 1:750 2ND ST NE
Practice Address - Street 2:SUITE 138
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8587
Practice Address - Country:US
Practice Address - Phone:952-303-3561
Practice Address - Fax:952-303-3562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343804251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health