Healthcare Provider Details

I. General information

NPI: 1902628217
Provider Name (Legal Business Name): OUR FAMILY HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5964 58TH ST. S
FARGO ND
58104
US

IV. Provider business mailing address

5964 58TH ST. S
FARGO ND
58104
US

V. Phone/Fax

Practice location:
  • Phone: 218-251-7066
  • Fax:
Mailing address:
  • Phone: 218-251-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: ANGELINA ZENON
Title or Position: OWNER/FOUNDER
Credential:
Phone: 218-251-7066