Healthcare Provider Details

I. General information

NPI: 1023774825
Provider Name (Legal Business Name): BASIC HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TWELVE OAKS CENTER DRIVE, SUITE 1018
WAYZATA MN
55391
US

IV. Provider business mailing address

1001 TWELVE OAKS CENTER DRIVE, SUITE 1018
WAYZATA MN
55391
US

V. Phone/Fax

Practice location:
  • Phone: 512-803-2021
  • Fax: 651-925-0423
Mailing address:
  • Phone: 512-803-2021
  • Fax: 651-925-0423

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: IRINA YAVELA
Title or Position: CEO/PRESIDENT
Credential:
Phone: 612-803-2021