MEDICARE: MK HOMECARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1760328421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MK HOMECARE LLC

Provider Business Mailing Address
First Line	:	1178 SUBURBAN AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-6448
Country	:	US
Telephone Number	:	612-542-4346
Fax Number	:

Provider Business Practice Location Address
First Line	:	1178 SUBURBAN AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-6448
Country	:	US
Telephone Number	:	612-542-4346
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL WATTS
Credential	:
Telephone Number	:	612-407-0230

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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