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General NPI Number Information
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NPI Number | 1144962994
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Entity Type | Organization
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Legal Business Name | JS & Y DEDICATED HEALTH CARE SERVICES LLC
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 13278 94TH AVE N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-9306
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Country | US
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Telephone | 952-454-8417
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Fax |
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Provider Business Mailing Address
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Address Line | 13278 94TH AVE N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-9306
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Country | US
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Telephone | 952-454-8305
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES BUKU KIMBER
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Credential |
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Telephone | 952-454-8305
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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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