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General NPI Number Information
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NPI Number | 1255986170
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Entity Type | Organization
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Legal Business Name | PRIDE HOME CARE CORP
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 6851 10TH AVE SW STE A
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City | ROCHESTER
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State | MN
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Zip | 55902-2512
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Country | US
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Telephone | 651-419-4555
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Fax | 651-504-6713
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Provider Business Mailing Address
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Address Line | 6851 10TH AVE SW STE A
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City | ROCHESTER
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State | MN
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Zip | 55902-2512
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Country | US
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Telephone | 651-419-4555
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Fax | 651-504-6713
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Authorized Official
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Title or Position | OWNER
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Name | MR. SAMUEL ADEMOLA ADEBAJO
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Credential |
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Telephone | 651-419-4555
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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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