Healthcare Provider Details

I. General information

NPI: 1689827586
Provider Name (Legal Business Name): YOUR CHOICE HOME CARE, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 JEFFERSON ST
ALEXANDRIA MN
56308-1822
US

IV. Provider business mailing address

PO BOX 83
ALEXANDRIA MN
56308-0083
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-1501
  • Fax: 320-219-7388
Mailing address:
  • Phone: 320-762-1501
  • Fax: 320-762-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1062488-1-ADC
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number335644
License Number StateMN

VIII. Authorized Official

Name: HEIDI ANDERSON
Title or Position: PARTNER
Credential:
Phone: 320-762-1501