Healthcare Provider Details

I. General information

NPI: 1578129342
Provider Name (Legal Business Name): MIDWAY HOME HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 RICE ST STE 2
SAINT PAUL MN
55117-3864
US

IV. Provider business mailing address

1459 RICE ST STE 2
SAINT PAUL MN
55117-3864
US

V. Phone/Fax

Practice location:
  • Phone: 651-793-6901
  • Fax: 651-776-5251
Mailing address:
  • Phone: 651-793-6901
  • Fax: 651-776-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KAYING LOR VANG
Title or Position: PRESIDENT
Credential:
Phone: 651-793-6901