Provider Demographics
NPI:1336512797
Name:PILGRIM HOME CARE, LLC
Entity Type:Organization
Organization Name:PILGRIM HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:Y
Authorized Official - Last Name:NYEMAH
Authorized Official - Suffix:III
Authorized Official - Credentials:RN
Authorized Official - Phone:763-400-1326
Mailing Address - Street 1:3300 COUNTY ROAD 10
Mailing Address - Street 2:SUITE 320M
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3072
Mailing Address - Country:US
Mailing Address - Phone:763-400-1326
Mailing Address - Fax:763-307-5942
Practice Address - Street 1:3300 COUNTY ROAD 10
Practice Address - Street 2:SUITE 320M
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3072
Practice Address - Country:US
Practice Address - Phone:763-400-1326
Practice Address - Fax:763-307-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-07
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32048251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health