Healthcare Provider Details

I. General information

NPI: 1982373049
Provider Name (Legal Business Name): PERSONAL CARE ASSISTANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 HIGHWAY 36 W # 481
SAINT PAUL MN
55113-3902
US

IV. Provider business mailing address

1610 COUNTY ROAD B W APT 1
ROSEVILLE MN
55113-4019
US

V. Phone/Fax

Practice location:
  • Phone: 616-634-1297
  • Fax: 651-393-4373
Mailing address:
  • Phone: 616-634-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: FADIL JAMA
Title or Position: PRESIDENT
Credential: RN
Phone: 616-634-1297