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General NPI Number Information
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NPI Number | 1942511522
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Entity Type | Organization
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Legal Business Name | GOLDEN CHOICE HOME CARE LLC
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 2151 HAMLINE AVE N SUITE # 110
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City | SAINT PAUL
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State | MN
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Zip | 55113-4236
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Country | US
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Telephone | 651-330-4840
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Fax | 651-330-4318
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Provider Business Mailing Address
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Address Line | 2151 HAMLINE AVENUE SUITE # 110
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City | ST. PAUL
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State | MN
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Zip | 55113
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Country | US
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Telephone | 651-330-4840
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Fax | 651-330-4318
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Authorized Official
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Title or Position | OWNER / MANAGER
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Name | KIROS TESFAYE
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Credential |
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Telephone | 651-330-4840
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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 | A652647000
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License Number State | MN
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