Healthcare Provider Details

I. General information

NPI: 1366163164
Provider Name (Legal Business Name): KATE DEES HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2366 55TH ST S APT 206
FARGO ND
58104-7625
US

IV. Provider business mailing address

2366 55TH ST S APT 206
FARGO ND
58104-7625
US

V. Phone/Fax

Practice location:
  • Phone: 312-404-8184
  • Fax:
Mailing address:
  • Phone: 312-404-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LASHAWN SHAMBLIN
Title or Position: OWNER
Credential:
Phone: 701-781-7844