Healthcare Provider Details

I. General information

NPI: 1215738745
Provider Name (Legal Business Name): KU4LOVE HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21854 DENTON AVE
FARMINGTON MN
55024-6012
US

IV. Provider business mailing address

21854 DENTON AVE
FARMINGTON MN
55024-6012
US

V. Phone/Fax

Practice location:
  • Phone: 612-458-7768
  • Fax:
Mailing address:
  • Phone: 612-458-7768
  • Fax:

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LONGCHI NDONGLA KUFOR
Title or Position: LICENSED PRACTICAL NURSE
Credential: LPN
Phone: 612-458-7768