Healthcare Provider Details

I. General information

NPI: 1619210077
Provider Name (Legal Business Name): PRESCRIPTION HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36144 RUSH LAKE LOOP
OTTERTAIL MN
56571-9430
US

IV. Provider business mailing address

36144 RUSH LAKE LOOP
OTTERTAIL MN
56571-9430
US

V. Phone/Fax

Practice location:
  • Phone: 218-371-7838
  • Fax:
Mailing address:
  • Phone: 218-371-7838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number29284
License Number StateMN

VIII. Authorized Official

Name: MS. ANA ILIANA KNIGHT
Title or Position: OWNER/PARTNER
Credential: R.N.
Phone: 218-371-7838