Provider Demographics
NPI:1295807196
Name:HOME INSTEAD SENIOR CARE #230, LLC
Entity type:Organization
Organization Name:HOME INSTEAD SENIOR CARE #230, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ENVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-544-5988
Mailing Address - Street 1:1710 DOUGLAS DR N STE 108
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4397
Mailing Address - Country:US
Mailing Address - Phone:763-544-5988
Mailing Address - Fax:763-544-6012
Practice Address - Street 1:1710 DOUGLAS DR N STE 108
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4397
Practice Address - Country:US
Practice Address - Phone:763-544-5988
Practice Address - Fax:763-544-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331125251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health