Healthcare Provider Details

I. General information

NPI: 1285706911
Provider Name (Legal Business Name): PEDIATRIC HOME RESPIRATORY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLEVELAND AVE N
ROSEVILLE MN
55113-1126
US

IV. Provider business mailing address

2800 CLEVELAND AVE N
ROSEVILLE MN
55113-1126
US

V. Phone/Fax

Practice location:
  • Phone: 651-642-1825
  • Fax: 652-638-0690
Mailing address:
  • Phone: 651-642-1825
  • Fax: 652-638-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CAMEO KAE ZEHNDER
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 651-642-1825