1396980793 NPI number — ANGELS OF MERCY HOMECARE SERVICES; INC.

Table of content: (NPI 1396980793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396980793 NPI number — ANGELS OF MERCY HOMECARE SERVICES; INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELS OF MERCY HOMECARE SERVICES; INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIVATE DUTY NURSE AGENCY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396980793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6018 HALIFAX PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55429-2440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-432-9706
Provider Business Mailing Address Fax Number:
763-432-9708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6018 HALIFAX PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN CENTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55429-2440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-432-9706
Provider Business Practice Location Address Fax Number:
763-432-9708
Provider Enumeration Date:
12/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ALLISON
Authorized Official First Name:
FOLUSO
Authorized Official Middle Name:
AYOTUNKU
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
763-432-9706

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  340166 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: 340801 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1366622615 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A432120000 . This is a "MHCP UMP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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