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General NPI Number Information
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NPI Number | 1083818496
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Entity Type | Organization
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Legal Business Name | WICARE SERVICES LLC
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10640 JUNIPER ST NW
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City | COON RAPIDS
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State | MN
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Zip | 55448-6511
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Country | US
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Telephone | 952-564-0631
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Fax | 952-881-0630
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Provider Business Mailing Address
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Address Line | 10640 JUNIPER ST NW
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City | COON RAPIDS
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State | MN
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Zip | 55448-6511
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Country | US
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Telephone | 952-564-0631
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Fax | 952-881-0630
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN NYAMEINO
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Credential | LPN
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Telephone | 952-564-0631
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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 | MN
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