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General NPI Number Information
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NPI Number | 1417757113
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Entity Type | Organization
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Legal Business Name | GREATMOORE HOME CARE AGENCY LLC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 433 RIVOLI DR
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City | SAINT PAUL
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State | MN
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Zip | 55130-4453
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Country | US
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Telephone | 612-231-2572
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Fax |
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Provider Business Mailing Address
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Address Line | 433 RIVOLI DR
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City | SAINT PAUL
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State | MN
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Zip | 55130-4453
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Country | US
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Telephone | 612-231-2572
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | HERMINE IRENE ADA
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Credential |
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Telephone | 612-231-2572
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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 |
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License Number State |
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