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General NPI Number Information
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NPI Number | 1023449022
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Entity Type | Organization
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Legal Business Name | TKMN, LLC
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 1500 MCANDREWS RD W SUITE 218
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City | BURNSVILLE
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State | MN
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Zip | 55337-4432
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Country | US
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Telephone | 952-892-8403
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Fax | 952-892-8405
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Provider Business Mailing Address
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Address Line | 1500 MCANDREWS RD W SUITE 218
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City | BURNSVILLE
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State | MN
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Zip | 55337-4432
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Country | US
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Telephone | 952-892-8403
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Fax | 952-892-8405
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT NENOVICH
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Credential |
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Telephone | 952-892-8403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 364354
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License Number State | MN
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