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General NPI Number Information
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NPI Number | 1750732202
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Entity Type | Organization
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Legal Business Name | MIRIAM HOME HEALTH CORPORATION
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/27/2016
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Provider Practice Location Address
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Address Line | 7030 HUMBOLDT AVENUE NORTH
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430
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Country | US
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Telephone | 763-458-4750
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Fax | 763-561-0738
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Provider Business Mailing Address
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Address Line | 7030 HUMBOLDT AVE N
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-1153
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Country | US
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Telephone | 763-458-4750
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Fax | 763-561-0738
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ALICE ISATU MANSARAY
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Credential | REGISTERED NURSE
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Telephone | 763-458-4750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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