=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477345676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOMISS HOME HEALTH CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2025
-----------------------------------------------------
Last Update Date | 05/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8652 KENYON CT NE UNIT F
-----------------------------------------------------
City | BLAINE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55449-7437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-800-6016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8652 KENYON CT NE UNIT F
-----------------------------------------------------
City | BLAINE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55449-7437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-800-6016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN/ CEO
-----------------------------------------------------
Name | IRENE CHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-800-6016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------