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General NPI Number Information
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NPI Number | 1114055464
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Entity Type | Organization
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Legal Business Name | PROMEDICAL HEALTH CARE
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1597 KNIGHT ST
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City | SHOREVIEW
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State | MN
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Zip | 55126-4571
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Country | US
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Telephone | 612-644-5764
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Fax | 952-841-6301
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Provider Business Mailing Address
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Address Line | 1597 KNIGHT ST
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City | SHOREVIEW
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State | MN
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Zip | 55126-4571
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Country | US
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Telephone | 612-644-5764
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Fax | 952-841-6301
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Authorized Official
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Title or Position | CEO
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Name | MR. KASHIF ALEXANDER GARLEY
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Credential |
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Telephone | 612-644-5764
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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 | 335372
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License Number State | MN
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