Provider Demographics
NPI:1104120302
Name:ST JOHN HOME CARE
Entity type:Organization
Organization Name:ST JOHN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MOPELOLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:AKINLOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-245-3474
Mailing Address - Street 1:1502 ARCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2146
Mailing Address - Country:US
Mailing Address - Phone:612-245-3474
Mailing Address - Fax:
Practice Address - Street 1:1502 ARCHWOOD RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2146
Practice Address - Country:US
Practice Address - Phone:612-245-3474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-02
Last Update Date:2011-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health