Healthcare Provider Details

I. General information

NPI: 1346796182
Provider Name (Legal Business Name): NORTHWEST HOME HEALTH CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 UNIVERSITY AVE W STE S348
SAINT PAUL MN
55104-2876
US

IV. Provider business mailing address

1487 GOODWIN AVE. N.
OAKDALE MN
55128-5701
US

V. Phone/Fax

Practice location:
  • Phone: 651-493-3834
  • Fax: 651-493-3835
Mailing address:
  • Phone: 651-493-3834
  • Fax: 651-493-3835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SYLVESTER KOKU AMELETSE
Title or Position: ADMINISTRATOR
Credential:
Phone: 651-493-3834