Healthcare Provider Details

I. General information

NPI: 1477100287
Provider Name (Legal Business Name): T & R HOMES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11409 SWALLOW ST NW
COON RAPIDS MN
55433-3643
US

IV. Provider business mailing address

1425 109TH LN NW
COON RAPIDS MN
55433-4214
US

V. Phone/Fax

Practice location:
  • Phone: 763-208-1028
  • Fax: 763-951-3788
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LASHAY MCKENZIE
Title or Position: MANAGER
Credential:
Phone: 763-807-1543