MEDICARE: IN HOME PERSONAL CARE, INC.

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	251E00000X	Home Health Agency	380316	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A026845300	OTHER	MN	UMPI

General Provider Information

NPI Number	:	1538377452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN HOME PERSONAL CARE, INC.

Provider Business Mailing Address
First Line	:	1330 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2607
Country	:	US
Telephone Number	:	763-546-1000
Fax Number	:	763-546-1018

Provider Business Practice Location Address
First Line	:	1330 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-2607
Country	:	US
Telephone Number	:	763-546-1000
Fax Number	:	763-546-1018

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ERIN GOVRIK
Credential	:
Telephone Number	:	763-546-1000

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/21/2022

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