MEDICARE: PATIENT CENTERED HOME CARE SERVICES, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	384330	MN

General Provider Information

NPI Number	:	1063901809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATIENT CENTERED HOME CARE SERVICES, LLC.

Provider Business Mailing Address
First Line	:	4127 SUNSET TER N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-1262
Country	:	US
Telephone Number	:	763-843-1014
Fax Number	:

Provider Business Practice Location Address
First Line	:	4127 SUNSET TER N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443
Country	:	US
Telephone Number	:	763-843-1014
Fax Number	:

Authorized Official
Title or Position	:	RN
Name	:	PRINCE DARJUE
Credential	:
Telephone Number	:	763-843-1014

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	07/19/2018

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