MEDICARE: 3KS HOMECARE 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	251J00000X	Nursing Care Agency	360520	MN

General Provider Information

NPI Number	:	1235561226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3KS HOMECARE LLC

Provider Business Mailing Address
First Line	:	7600 BASS LAKE RD
Second Line	:
City	:	NEW HOPE
State	:	MN
Zip	:	55428-3860
Country	:	US
Telephone Number	:	763-544-3148
Fax Number	:	763-544-3149

Provider Business Practice Location Address
First Line	:	7600 BASS LAKE RD
Second Line	:
City	:	NEW HOPE
State	:	MN
Zip	:	55428-3860
Country	:	US
Telephone Number	:	763-544-3148
Fax Number	:	763-544-3149

Authorized Official
Title or Position	:	OWNER
Name	:	NORLANE SLOAN
Credential	:	RN
Telephone Number	:	763-544-3148

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/01/2013

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