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General NPI Number Information
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NPI Number | 1194677708
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Entity Type | Organization
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Legal Business Name | PENNEH ISSIE HOME HEALTHCARE
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Dates
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Enumeration Date | 02/14/2026
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Last Update Date | 02/14/2026
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Provider Practice Location Address
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Address Line | 19141 JOHNSON ST NW
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City | ELK RIVER
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State | MN
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Zip | 55330-7088
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Country | US
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Telephone | 763-321-0809
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Fax |
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Provider Business Mailing Address
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Address Line | 19141 JOHNSON ST NW
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City | ELK RIVER
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State | MN
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Zip | 55330-7088
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Country | US
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Telephone | 763-321-0809
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ANTHONY J KABA
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Credential |
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Telephone | 763-321-0809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SH0200X
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Taxonomy Name | Home Health Clinical Nurse Specialist
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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