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General NPI Number Information
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NPI Number | 1043747496
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Entity Type | Organization
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Legal Business Name | LIVE AT HOME PERSONAL CARE INC
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 05/16/2017
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Provider Practice Location Address
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Address Line | 624 FULLER AVE STE 206
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City | SAINT PAUL
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State | MN
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Zip | 55104-4865
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Country | US
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Telephone | 651-200-3077
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Fax | 651-200-3077
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Provider Business Mailing Address
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Address Line | 624 FULLER AVE STE 206
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City | SAINT PAUL
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State | MN
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Zip | 55104-4865
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Country | US
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Telephone | 651-200-3077
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Fax | 651-200-3624
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Authorized Official
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Title or Position | MANAGER
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Name | MAISENG YANG
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Credential |
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Telephone | 651-200-3077
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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 |
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License Number State |
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