Healthcare Provider Details

I. General information

NPI: 1134917081
Provider Name (Legal Business Name): LINWOOD HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24030 TYPO CREEK DR NE
STACY MN
55079-6716
US

IV. Provider business mailing address

38868 12TH AVE # 1149
NORTH BRANCH MN
55056-6658
US

V. Phone/Fax

Practice location:
  • Phone: 320-455-2871
  • Fax:
Mailing address:
  • Phone: 763-297-0397
  • Fax: 763-402-7692

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
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: PA KOU MOUA
Title or Position: CEO
Credential:
Phone: 763-297-0397