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General NPI Number Information
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NPI Number | 1336449438
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Entity Type | Organization
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Legal Business Name | 1 GALAXY OF DIVINE HOMECARE SERVICES, INC.
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Dates
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Enumeration Date | 10/24/2010
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Last Update Date | 10/24/2010
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Provider Practice Location Address
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Address Line | 13570 GROVE DR STE #211
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City | MAPLE GROVE
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State | MN
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Zip | 55311-4400
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Country | US
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Telephone | 763-390-2586
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Fax |
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Provider Business Mailing Address
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Address Line | 13570 GROVE DR STE #211
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City | MAPLE GROVE
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State | MN
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Zip | 55311-4400
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Country | US
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Telephone | 763-390-2586
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Fax |
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Authorized Official
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Title or Position | ODS
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Name | ALEXANDER BASSEY-BLACK
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Credential |
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Telephone | 763-390-2586
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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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