Healthcare Provider Details

I. General information

NPI: 1578292991
Provider Name (Legal Business Name): 2BROS CARES PROFESSIONAL SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 NORTHTOWN DR NE
BLAINE MN
55434-1036
US

IV. Provider business mailing address

169 NORTHTOWN DR NE
BLAINE MN
55434-1036
US

V. Phone/Fax

Practice location:
  • Phone: 763-402-2597
  • Fax:
Mailing address:
  • Phone: 763-402-2597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY ALLEN HALLADA
Title or Position: OWNER/CEO
Credential:
Phone: 763-402-2597