Healthcare Provider Details

I. General information

NPI: 1659914943
Provider Name (Legal Business Name): PRLFC CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2019
Last Update Date: 10/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 BASSWOOD RD
MEDINA MN
55340-8806
US

IV. Provider business mailing address

3049 BASSWOOD RD
MEDINA MN
55340-8806
US

V. Phone/Fax

Practice location:
  • Phone: 952-855-2495
  • Fax:
Mailing address:
  • Phone: 952-855-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAUD GABEYRE
Title or Position: OWNER
Credential:
Phone: 952-855-2495