Healthcare Provider Details

I. General information

NPI: 1962810051
Provider Name (Legal Business Name): ABBEYCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 GRAND AVENUE
ST. PAUL MN
55105
US

IV. Provider business mailing address

1148 GRAND AVENUE
ST. PAUL MN
55105
US

V. Phone/Fax

Practice location:
  • Phone: 651-690-5352
  • Fax: 651-209-8065
Mailing address:
  • Phone: 651-690-5352
  • Fax: 651-209-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR-2065250
License Number StateMN

VIII. Authorized Official

Name: LILIYA GOKHBERG
Title or Position: CEO
Credential:
Phone: 651-690-5352