=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174061493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLISTIC HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2017
-----------------------------------------------------
Last Update Date | 02/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2321 CASCADE PLZ S
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55125-1606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-283-9564
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 661 EAGLE RIDGE RD
-----------------------------------------------------
City | WOODBURY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55125-1461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-283-9564
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. LYNDA DUOSEKE ABAGI
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 651-283-9564
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 379672
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------