MEDICARE: YOUR HOME CARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332U00000X	Home Delivered Meals
2	347C00000X	Private Vehicle
3	385H00000X	Respite Care
4	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1235697459
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	1306 67TH AVE N APT 306
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-1572
Country	:	US
Telephone Number	:	651-335-4778
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 67TH AVE N APT 306
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-1572
Country	:	US
Telephone Number	:	651-335-4778
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, OWNER
Name	:	MS. KIARA CLARK
Credential	:
Telephone Number	:	651-335-4778

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	03/06/2019

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