MEDICARE: KING DAVID HOME HEALTH CARE SERVICES

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		MN

General Provider Information

NPI Number	:	1588832216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING DAVID HOME HEALTH CARE SERVICES

Provider Business Mailing Address
First Line	:	7758 JANERO COURT SO.
Second Line	:
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016
Country	:	US
Telephone Number	:	651-459-5023
Fax Number	:	651-769-0788

Provider Business Practice Location Address
First Line	:	7758 JANERO CT
Second Line	:
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-2217
Country	:	US
Telephone Number	:	651-459-5023
Fax Number	:	651-769-0788

Authorized Official
Title or Position	:	CEO
Name	:	MS. BONITA L. ADAMS
Credential	:	BBC. DEGREE
Telephone Number	:	651-459-5023

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	02/15/2008

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