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General NPI Number Information
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NPI Number | 1487477295
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Entity Type | Organization
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Legal Business Name | MANDE FAMILY CARE LLC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 2610 CUTTES GROVE AVE 205
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City | ANOKA
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State | MN
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Zip | 55303
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Country | US
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Telephone | 612-707-1603
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Fax |
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Provider Business Mailing Address
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Address Line | 2610 CUTTERS GROVE AVE APT 205
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City | ANOKA
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State | MN
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Zip | 55303-6263
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Country | US
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Telephone | 612-707-1603
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KOLLEY SANYANG
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Credential |
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Telephone | 612-707-1603
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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 | 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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