=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104252410
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIND HEARTS HEALTH CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2013
-----------------------------------------------------
Last Update Date | 09/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3505 PENN AVE N SUITE B
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55412-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-998-1688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3505 PENN AVE N SUITE B
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55412-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-998-1688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PAMELA CONDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-998-1688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------