=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588734966
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAREMATE HOME HEALTH CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2236 MARSHALL AVENUE
-----------------------------------------------------
City | ST PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-5799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-659-0208
-----------------------------------------------------
Fax | 651-659-0161
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2236 MARSHALL AVENUE
-----------------------------------------------------
City | ST PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-5799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-659-0208
-----------------------------------------------------
Fax | 651-659-0161
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CEO
-----------------------------------------------------
Name | MICHAEL ADERINKOMI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-659-0208
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 331580
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------