Healthcare Provider Details

I. General information

NPI: 1821428012
Provider Name (Legal Business Name): JUANITA'S HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 EDINBROOK XING APT 331
BROOKLYN PARK MN
55443-4015
US

IV. Provider business mailing address

8601 EDINBROOK XING APT 331
BROOKLYN PARK MN
55443-4015
US

V. Phone/Fax

Practice location:
  • Phone: 763-486-3131
  • Fax:
Mailing address:
  • Phone: 763-486-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSE ENRIQUE PEREZ
Title or Position: OWNER
Credential:
Phone: 763-486-3131