Healthcare Provider Details

I. General information

NPI: 1447741152
Provider Name (Legal Business Name): MODERN SISTER'S HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31533 FOREST BLVD
STACY MN
55079-9238
US

IV. Provider business mailing address

31533 FOREST BLVD
STACY MN
55079-9238
US

V. Phone/Fax

Practice location:
  • Phone: 763-754-6732
  • Fax: 763-754-6179
Mailing address:
  • Phone: 763-754-6732
  • Fax: 763-754-6179

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: MARY YANG
Title or Position: OWNER
Credential: PHARM. D
Phone: 763-754-6732