=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831751098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EPIPHANY CARE HOMES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2019
-----------------------------------------------------
Last Update Date | 07/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3704 CARDINAL RD
-----------------------------------------------------
City | MINNETONKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55345-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-900-0111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8260 BENWOOD CIR
-----------------------------------------------------
City | CHANHASSEN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55317-9380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-900-0111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. AIMEE SLAUGHTER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 651-900-0111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------