Healthcare Provider Details

I. General information

NPI: 1114396546
Provider Name (Legal Business Name): MOTHER TERESA HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 BASS LAKE RD
NEW HOPE MN
55428-3000
US

IV. Provider business mailing address

9220 BASS LAKE RD
NEW HOPE MN
55428-3000
US

V. Phone/Fax

Practice location:
  • Phone: 612-978-3940
  • Fax:
Mailing address:
  • Phone: 612-978-3940
  • 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. FASCIL BIRHANU DUBALE
Title or Position: OWNER
Credential:
Phone: 612-978-3940