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General NPI Number Information
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NPI Number | 1285923748
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Entity Type | Organization
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Legal Business Name | MORGATHA HOME HEALTH CARE, INC.
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 6000 BASS LAKE RD SUITE 111
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City | CRYSTAL
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State | MN
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Zip | 55429-2700
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Country | US
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Telephone | 612-533-0022
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Fax | 612-533-0044
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Provider Business Mailing Address
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Address Line | 6000 BASS LAKE RD SUITE 111
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City | CRYSTAL
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State | MN
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Zip | 55429-2700
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Country | US
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Telephone | 612-533-0022
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Fax | 612-533-0044
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARDOE MONGARDOE CEPHAS
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Credential | M.D.
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Telephone | 612-812-9147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1932824
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License Number State | MN
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