Healthcare Provider Details

I. General information

NPI: 1750535746
Provider Name (Legal Business Name): CARRIE ANNS HOMECARE HOUSES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22550 MARIE AVE
ROGERS MN
55374-5808
US

IV. Provider business mailing address

22550 MARIE AVE
ROGERS MN
55374-5808
US

V. Phone/Fax

Practice location:
  • Phone: 612-730-6849
  • Fax:
Mailing address:
  • Phone: 612-730-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberR 1535134
License Number StateMN

VIII. Authorized Official

Name: LATASHA D VINES
Title or Position: CEO
Credential: RN
Phone: 612-730-6849