Provider Demographics
NPI:1750732202
Name:MIRIAM HOME HEALTH CORPORATION
Entity type:Organization
Organization Name:MIRIAM HOME HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:ISATU
Authorized Official - Last Name:MANSARAY
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:763-458-4750
Mailing Address - Street 1:7030 HUMBOLDT AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1153
Mailing Address - Country:US
Mailing Address - Phone:763-458-4750
Mailing Address - Fax:763-561-0738
Practice Address - Street 1:7030 HUMBOLDT AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430
Practice Address - Country:US
Practice Address - Phone:763-458-4750
Practice Address - Fax:763-561-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities