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General NPI Number Information
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NPI Number | 1124363056
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Entity Type | Organization
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Legal Business Name | DIVERSEY HOME CARE, LLC
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 6631 URBANDALE LN N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-1374
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Country | US
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Telephone | 952-388-7368
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Fax |
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Provider Business Mailing Address
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Address Line | 6631 URBANDALE LN N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-1374
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Country | US
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Telephone | 952-388-7368
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Fax |
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Authorized Official
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Title or Position | CARE MANAGER/OWNER
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Name | MRS. WINONNA PALO
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Credential | RN
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Telephone | 952-388-7368
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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 | 360193
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License Number State | MN
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