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General NPI Number Information
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NPI Number | 1700243649
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Entity Type | Organization
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Legal Business Name | MINNESOTAWEST HOME HEALTHCARE INC
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 3403 KILMER LN N
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City | PLYMOUTH
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State | MN
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Zip | 55441-2415
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Country | US
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Telephone | 763-432-9172
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Fax | 763-276-9930
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Provider Business Mailing Address
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Address Line | 3403 KILMER LN N
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City | PLYMOUTH
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State | MN
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Zip | 55441-2415
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Country | US
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Telephone | 763-432-9172
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Fax | 763-276-9930
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNEDY MOGERE
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Credential |
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Telephone | 763-458-9072
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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 | 380470
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License Number State | MN
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