Provider Demographics
NPI:1154567436
Name:CROWN MEDICAL HOME HEALTH AGENCY INC
Entity type:Organization
Organization Name:CROWN MEDICAL HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:IHIOMA
Authorized Official - Last Name:ONYEKABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-978-3783
Mailing Address - Street 1:1925/1931 1ST AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3724
Mailing Address - Country:US
Mailing Address - Phone:612-978-3783
Mailing Address - Fax:
Practice Address - Street 1:1925/1931 1ST AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3724
Practice Address - Country:US
Practice Address - Phone:612-978-3783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROWN MEDICAL HOME HEALTH AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN342349310400000X
MN338043313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility