Healthcare Provider Details

I. General information

NPI: 1851668594
Provider Name (Legal Business Name): HOME INSTEAD SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10155 UNIVERSITY AVE NE #100
BLAINE MN
55434-8017
US

IV. Provider business mailing address

406 GREAT OAK DR
WAITE PARK MN
56387-2504
US

V. Phone/Fax

Practice location:
  • Phone: 763-792-0041
  • Fax: 763-792-0043
Mailing address:
  • Phone: 320-258-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL ARNOLD
Title or Position: OWNER
Credential:
Phone: 320-258-3055