Healthcare Provider Details

I. General information

NPI: 1235697459
Provider Name (Legal Business Name): YOUR HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 67TH AVE N APT 306
BROOKLYN CENTER MN
55430-1572
US

IV. Provider business mailing address

1306 67TH AVE N APT 306
BROOKLYN CENTER MN
55430-1572
US

V. Phone/Fax

Practice location:
  • Phone: 651-335-4778
  • Fax:
Mailing address:
  • Phone: 651-335-4778
  • 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 Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. KIARA CLARK
Title or Position: PRESIDENT, OWNER
Credential:
Phone: 651-335-4778