Healthcare Provider Details

I. General information

NPI: 1740541135
Provider Name (Legal Business Name): RELIABLE HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2012
Last Update Date: 06/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 JORDAN AVE N
NEW HOPE MN
55427-1051
US

IV. Provider business mailing address

4113 JORDAN AVE N
NEW HOPE MN
55427-1051
US

V. Phone/Fax

Practice location:
  • Phone: 763-218-4147
  • 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: MICHAEL ANSUMANA PADMORE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 763-218-4147