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General NPI Number Information
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NPI Number | 1396048773
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Entity Type | Organization
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Legal Business Name | HOMECARE RESOURCE LLC
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 900 AMERICAN BLVD E SUITE 100
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City | BLOOMINGTON
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State | MN
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Zip | 55420-1392
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Country | US
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Telephone | 952-854-6104
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Fax |
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Provider Business Mailing Address
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Address Line | 900 AMERICAN BLVD E SUITE 100
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City | BLOOMINGTON
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State | MN
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Zip | 55420-1392
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARIE L DEVOLITES
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Credential |
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Telephone | 952-854-6104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 332246
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License Number State | MN
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