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General NPI Number Information
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NPI Number | 1467274696
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Entity Type | Organization
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Legal Business Name | SELAM HOME CARE LLC
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 2184 COUNTY ROAD E E
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-4706
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Country | US
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Telephone | 651-587-7584
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Fax |
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Provider Business Mailing Address
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Address Line | 2184 COUNTY ROAD E E
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City | WHITE BEAR LAKE
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State | MN
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Zip | 55110-4706
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Country | US
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Telephone | 651-587-7584
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HAYMANOT MEKURIA
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Credential | RN
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Telephone | 651-587-7584
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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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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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