=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891064309
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARING HEARTS AT HOME, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2011
-----------------------------------------------------
Last Update Date | 12/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 BALSAM LN
-----------------------------------------------------
City | ROCKFORD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55373-4587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-592-9906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 BALSAM LN
-----------------------------------------------------
City | ROCKFORD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55373-4587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-592-9906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CNA
-----------------------------------------------------
Name | MS. CATHERINE SIMON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-592-9906
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 3991028-2
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------