=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013734672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALAMA HOME CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2024
-----------------------------------------------------
Last Update Date | 12/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14801 ERKIUM ST NW
-----------------------------------------------------
City | RAMSEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55303-5146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-300-6463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14801 ERKIUM ST NW
-----------------------------------------------------
City | RAMSEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55303-5146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE
-----------------------------------------------------
Name | MICHELINE MUSUNGU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-499-0704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------