Healthcare Provider Details

I. General information

NPI: 1942436332
Provider Name (Legal Business Name): ATTENTIVE HOME HEALTHCARE MINNESOTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15430 18TH AVE N STE-1312
PLYMOUTH MN
55447-2432
US

IV. Provider business mailing address

15430 18TH AVE N STE-1312
PLYMOUTH MN
55447-2432
US

V. Phone/Fax

Practice location:
  • Phone: 763-354-4434
  • Fax:
Mailing address:
  • Phone: 763-354-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number344134
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number344134
License Number StateMN

VIII. Authorized Official

Name: MRS. ELIZA PORTE DAVIES
Title or Position: PRESIDENT/DIRECTOR OF NURSING
Credential: RN
Phone: 763-354-4434