Healthcare Provider Details

I. General information

NPI: 1255816823
Provider Name (Legal Business Name): A & F DEPENDABLE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2018
Last Update Date: 09/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10299 UNIVERSITY AVE NE
BLAINE MN
55434-8020
US

IV. Provider business mailing address

10299 UNIVERSITY AVE NE
BLAINE MN
55434-8020
US

V. Phone/Fax

Practice location:
  • Phone: 651-278-9560
  • Fax:
Mailing address:
  • Phone: 651-278-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KINSEY AYANGIM
Title or Position: OWNER/MANAGER
Credential:
Phone: 651-278-9560