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General NPI Number Information
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NPI Number | 1881334076
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Entity Type | Organization
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Legal Business Name | ESSENTIAL HOME LLC
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 2345 RICE ST # 173
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City | ROSEVILLE
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State | MN
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Zip | 55113-3741
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Country | US
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Telephone | 612-456-4565
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Fax | 651-846-4517
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Provider Business Mailing Address
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Address Line | 2345 RICE ST # 173
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City | ROSEVILLE
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State | MN
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Zip | 55113-3741
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Country | US
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Telephone | 612-456-4565
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Fax | 651-846-4517
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Authorized Official
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Title or Position | OWNER
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Name | MAI LEE VANG
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Credential |
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Telephone | 612-456-4565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #6
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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 #7
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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