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General NPI Number Information
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NPI Number | 1477789196
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Entity Type | Organization
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Legal Business Name | H.O.M.E. PROGRAM
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 06/09/2009
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Provider Practice Location Address
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Address Line | 9801 PENN AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2912
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Country | US
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Telephone | 952-888-5530
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Fax | 952-881-1052
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Provider Business Mailing Address
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Address Line | 9801 PENN AVE S
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2912
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Country | US
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Telephone | 952-888-5530
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Fax | 952-881-1052
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Authorized Official
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Title or Position | H.O.M.E. PROGRAM DIRECTOR
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Name | MRS. KITTY ENGLE
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Credential |
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Telephone | 952-888-5530
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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 | MN
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