Healthcare Provider Details

I. General information

NPI: 1467916205
Provider Name (Legal Business Name): 24 - SEVEN HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 W BROADWAY AVE STE 202D
BROOKLYN PARK MN
55428-1692
US

IV. Provider business mailing address

7111 W BROADWAY AVE STE 202D
BROOKLYN PARK MN
55428-1692
US

V. Phone/Fax

Practice location:
  • Phone: 612-886-2828
  • Fax:
Mailing address:
  • Phone: 612-886-2828
  • Fax: 612-886-2861

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: OVIE AVWENAGHAGHA
Title or Position: CEO
Credential:
Phone: 612-886-2828