Healthcare Provider Details

I. General information

NPI: 1063281764
Provider Name (Legal Business Name): DAKOTA HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 W PECAN RD
PHOENIX AZ
85041-4425
US

IV. Provider business mailing address

2918 W PECAN RD
PHOENIX AZ
85041-4425
US

V. Phone/Fax

Practice location:
  • Phone: 701-215-1769
  • Fax:
Mailing address:
  • Phone: 701-215-1769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: SAIDO IGAL
Title or Position: OWNER
Credential:
Phone: 701-215-1769