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General NPI Number Information
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NPI Number | 1972672871
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Entity Type | Organization
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Legal Business Name | BANGEM INC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8593 SAVANNA OAKS LN
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City | WOODBURY
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State | MN
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Zip | 55125-9611
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Country | US
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Telephone | 651-501-3661
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Fax | 651-730-1664
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Provider Business Mailing Address
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Address Line | 8593 SAVANNA OAKS LN
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City | WOODBURY
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State | MN
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Zip | 55125-9611
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Country | US
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Telephone | 651-501-3661
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Fax | 651-730-1664
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WILSON NDILLE EKINDE
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Credential | REGISTERED NURSE
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Telephone | 651-329-7272
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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 | 331175
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License Number State | MN
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