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General NPI Number Information
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NPI Number | 1306068010
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Entity Type | Organization
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Legal Business Name | HMONG HOME HEALTH CARE, LLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 475 ETNA ST STE 3
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City | SAINT PAUL
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State | MN
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Zip | 55106-5845
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Country | US
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Telephone | 651-488-1680
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Fax |
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Provider Business Mailing Address
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Address Line | 933 WHITE BEAR AVE N
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City | SAINT PAUL
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State | MN
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Zip | 55106-3014
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Country | US
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Telephone | 651-488-1680
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARCUS BRADLEY
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Credential |
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Telephone | 651-262-5514
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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 | 738345200
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License Number State | MN
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