Healthcare Provider Details

I. General information

NPI: 1902334576
Provider Name (Legal Business Name): HOMERUN TRANSITION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 BATTLE CREEK PL
SAINT PAUL MN
55119-4909
US

IV. Provider business mailing address

33 BATTLE CREEK PL
SAINT PAUL MN
55119-4909
US

V. Phone/Fax

Practice location:
  • Phone: 651-263-2866
  • Fax:
Mailing address:
  • Phone: 651-263-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TOU SU TAYLOR KONG
Title or Position: MANAGER
Credential:
Phone: 651-263-2866