Healthcare Provider Details

I. General information

NPI: 1609432806
Provider Name (Legal Business Name): SENITE HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 CHICAGO AVE APT 811
MINNEAPOLIS MN
55407-4323
US

IV. Provider business mailing address

PO BOX 7471
MINNEAPOLIS MN
55407-0471
US

V. Phone/Fax

Practice location:
  • Phone: 612-849-6750
  • Fax:
Mailing address:
  • Phone: 612-849-6750
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMARA C RICHARD
Title or Position: OWNER
Credential:
Phone: 612-849-6750