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General NPI Number Information
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NPI Number | 1598300048
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Entity Type | Organization
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Legal Business Name | CITY OF LAKES HOME CARE LLC
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 393 N DUNLAP ST SUITE 450H
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City | SAINT PAUL
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State | MN
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Zip | 55104-4238
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Country | US
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Telephone | 573-355-0177
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Fax | 651-528-8346
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Provider Business Mailing Address
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Address Line | 393 N DUNLAP ST SUITE 450H
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City | SAINT PAUL
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State | MN
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Zip | 55104-4238
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Country | US
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Telephone | 573-355-0177
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Fax | 651-528-8346
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | HODAN ALI SALAT
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Credential |
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Telephone | 651-398-5667
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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