Healthcare Provider Details

I. General information

NPI: 1952978728
Provider Name (Legal Business Name): MARY R. SENIOR CARE & HOME CARE SERVICES AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 S 4TH ST APT M3306
MINNEAPOLIS MN
55454-1364
US

IV. Provider business mailing address

1615 S 4TH ST APT M3306
MINNEAPOLIS MN
55454-1364
US

V. Phone/Fax

Practice location:
  • Phone: 952-688-9499
  • Fax:
Mailing address:
  • Phone: 952-688-9499
  • 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: DININA DAVIS
Title or Position: PRESIDENT/OWNER
Credential: RN
Phone: 952-688-9499