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General NPI Number Information
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NPI Number | 1568325660
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Entity Type | Organization
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Legal Business Name | COMFORT CARE PCA LLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 1970 KENNARD ST
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City | MAPLEWOOD
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State | MN
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Zip | 55109-3603
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Country | US
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Telephone | 715-393-7369
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Fax |
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Provider Business Mailing Address
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Address Line | 907 S 11TH ST
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City | WAUSAU
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State | WI
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Zip | 54403-6512
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HER MEE THAO
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Credential |
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Telephone | 715-393-7369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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