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General NPI Number Information
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NPI Number | 1154837920
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Entity Type | Organization
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Legal Business Name | HOME CARE PLUS LLC
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 2435 136TH LN NW
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City | ANDOVER
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State | MN
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Zip | 55304-3872
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Country | US
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Telephone | 612-244-4611
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Fax |
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Provider Business Mailing Address
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Address Line | 2435 136TH LN NW
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City | ANDOVER
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State | MN
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Zip | 55304-3872
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Country | US
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Telephone | 612-244-4611
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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. STEPHEN MOKANDU OMAE
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Credential |
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Telephone | 612-244-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 1060451-1-AFC
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License Number State | MN
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