Provider Demographics
NPI:1700243649
Name:MINNESOTAWEST HOME HEALTHCARE INC
Entity Type:Organization
Organization Name:MINNESOTAWEST HOME HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-458-9072
Mailing Address - Street 1:3403 KILMER LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-2415
Mailing Address - Country:US
Mailing Address - Phone:763-432-9172
Mailing Address - Fax:763-276-9930
Practice Address - Street 1:3403 KILMER LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2415
Practice Address - Country:US
Practice Address - Phone:763-432-9172
Practice Address - Fax:763-276-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN380470251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health