Healthcare Provider Details

I. General information

NPI: 1770310617
Provider Name (Legal Business Name): WELLNESS HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BROADWAY AVE N
ROCHESTER MN
55906-3720
US

IV. Provider business mailing address

113 BROADWAY AVE N
ROCHESTER MN
55906-3720
US

V. Phone/Fax

Practice location:
  • Phone: 507-206-0840
  • Fax: 507-206-0318
Mailing address:
  • Phone: 507-206-0840
  • Fax: 507-206-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MARC DAVIS PAYE
Title or Position: OWNER/EMPLOYEE
Credential: TMA/CNA
Phone: 202-460-7311