Healthcare Provider Details

I. General information

NPI: 1104060854
Provider Name (Legal Business Name): TJ HOME SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2009
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 36TH AVE N #319
NEW HOPE MN
55427-1975
US

IV. Provider business mailing address

8015 36TH AVE N #319
NEW HOPE MN
55427-1975
US

V. Phone/Fax

Practice location:
  • Phone: 612-644-5769
  • Fax:
Mailing address:
  • Phone: 612-644-5769
  • 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: JAMES DORBOR FLAH
Title or Position: CEO
Credential:
Phone: 612-644-5769