Provider Demographics
NPI:1669939054
Name:SISTERCARE, LLC.
Entity type:Organization
Organization Name:SISTERCARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:MAI DER
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:651-500-9886
Mailing Address - Street 1:1852 131ST LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-1385
Mailing Address - Country:US
Mailing Address - Phone:651-500-9886
Mailing Address - Fax:
Practice Address - Street 1:311 S NICOLLET ST
Practice Address - Street 2:
Practice Address - City:BLUE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56013-1313
Practice Address - Country:US
Practice Address - Phone:651-332-0497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty