Provider Demographics
NPI:1841420155
Name:POLLEMA HOMECARE, LLC
Entity type:Organization
Organization Name:POLLEMA HOMECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:POLLEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-274-2191
Mailing Address - Street 1:326 E 8TH ST
Mailing Address - Street 2:STE. 106A
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-7029
Mailing Address - Country:US
Mailing Address - Phone:605-274-2191
Mailing Address - Fax:605-274-2196
Practice Address - Street 1:326 E 8TH ST
Practice Address - Street 2:STE. 106A
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-7029
Practice Address - Country:US
Practice Address - Phone:605-274-2191
Practice Address - Fax:605-274-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD193400000XMedicaid