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General NPI Number Information
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NPI Number | 1124641196
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Entity Type | Organization
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Legal Business Name | KINDLY CARE RESIDENT LLC
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Dates
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Enumeration Date | 05/25/2020
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Last Update Date | 05/25/2020
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Provider Practice Location Address
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Address Line | 605 WHITALL ST
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City | SAINT PAUL
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State | MN
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Zip | 55130-4155
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Country | US
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Telephone | 651-855-8437
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Fax |
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Provider Business Mailing Address
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Address Line | 605 WHITALL ST
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City | SAINT PAUL
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State | MN
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Zip | 55130-4155
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Country | US
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Telephone | 651-855-8437
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOTOO KEDIR NEBI
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Credential |
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Telephone | 651-855-8437
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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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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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