Provider Demographics
NPI:1396980793
Name:ANGELS OF MERCY HOMECARE SERVICES; INC.
Entity type:Organization
Organization Name:ANGELS OF MERCY HOMECARE SERVICES; INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FOLUSO
Authorized Official - Middle Name:AYOTUNKU
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-432-9706
Mailing Address - Street 1:6018 HALIFAX PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2440
Mailing Address - Country:US
Mailing Address - Phone:763-432-9706
Mailing Address - Fax:763-432-9708
Practice Address - Street 1:6018 HALIFAX PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2440
Practice Address - Country:US
Practice Address - Phone:763-432-9706
Practice Address - Fax:763-432-9708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELS OF MERCY HOMECARE SERVICES; INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-13
Last Update Date:2008-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN340801314000000X
MN340166251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1366622615Medicaid
MNA432120000OtherMHCP UMP