Healthcare Provider Details

I. General information

NPI: 1730466533
Provider Name (Legal Business Name): DEPENDABLE HOME HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2984 RICE ST
LITTLE CANADA MN
55113-2230
US

IV. Provider business mailing address

2984 RICE ST
LITTLE CANADA MN
55113-2230
US

V. Phone/Fax

Practice location:
  • Phone: 651-779-9810
  • Fax: 651-779-9809
Mailing address:
  • Phone: 651-779-9810
  • Fax: 651-779-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberA797345400
License Number StateMN

VIII. Authorized Official

Name: MR. ISAAC KWESI MENSAH
Title or Position: ADMNISTRATOR
Credential:
Phone: 651-779-9810