Healthcare Provider Details

I. General information

NPI: 1154148906
Provider Name (Legal Business Name): LATJOR HOME CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CIVIC CENTER PLZ STE 3000B
MANKATO MN
56001-7713
US

IV. Provider business mailing address

12 CIVIC CENTER PLZ STE 3000B
MANKATO MN
56001-7713
US

V. Phone/Fax

Practice location:
  • Phone: 507-769-9411
  • Fax:
Mailing address:
  • Phone: 507-769-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: YIEN BUOP
Title or Position: CEO
Credential:
Phone: 507-769-9411