Provider Demographics
NPI:1952566093
Name:CARING PROFESSIONALS HOMECARE, LLC
Entity Type:Organization
Organization Name:CARING PROFESSIONALS HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WACKERFUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-789-2299
Mailing Address - Street 1:1543 COMO AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2544
Mailing Address - Country:US
Mailing Address - Phone:651-789-2299
Mailing Address - Fax:651-306-1359
Practice Address - Street 1:1543 COMO AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108
Practice Address - Country:US
Practice Address - Phone:651-789-2299
Practice Address - Fax:651-306-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN014N0CAOtherBLUE PLUS
MNA609402000Medicaid
MN185876OtherUCARE
MN185876OtherUCARE