MEDICARE: ENRICHING 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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1437872413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENRICHING HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	9234 UPLAND LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-8454
Country	:	US
Telephone Number	:	763-232-4946
Fax Number	:

Provider Business Practice Location Address
First Line	:	9234 UPLAND LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-8454
Country	:	US
Telephone Number	:	763-232-4946
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEJYANA CLARK
Credential	:
Telephone Number	:	763-232-4946

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	09/23/2022

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