Healthcare Provider Details

I. General information

NPI: 1366373094
Provider Name (Legal Business Name): PRUDENTIAL HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S 8TH ST APT 704
MINNEAPOLIS MN
55404-7515
US

IV. Provider business mailing address

615 S 8TH ST APT 704
MINNEAPOLIS MN
55404-7515
US

V. Phone/Fax

Practice location:
  • Phone: 612-458-5311
  • Fax:
Mailing address:
  • Phone:
  • 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: GETRUDE SIRYA
Title or Position: MGR
Credential: RN
Phone: 612-458-5311