1568101467 NPI number — PURPLE VINE HOME CARE

Table of content: (NPI 1568101467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568101467 NPI number — PURPLE VINE HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PURPLE VINE HOME CARE
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:
Provider Other Organization Name Type Code:
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:
1568101467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13888 88TH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTSEGO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55330-0079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-227-8846
Provider Business Mailing Address Fax Number:
763-592-8085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3018 THURBER RD
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:
55429-1858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-227-8846
Provider Business Practice Location Address Fax Number:
763-592-8085
Provider Enumeration Date:
05/31/2022

Additional Information

Authorized Official

Authorized Official Last Name:
KAPILA
Authorized Official First Name:
ANGELIQUE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER/ ASSISTED LIVING DIRECTOR
Authorized Official Telephone Number:
763-227-8846

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1851953343 . This is a "GROUP HOME" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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