Provider Demographics
NPI:1154968824
Name:RISEN HOME CARE LLC
Entity type:Organization
Organization Name:RISEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:BIAKASASA
Authorized Official - Last Name:KAPILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-227-8846
Mailing Address - Street 1:11670 FOUNTAINS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7195
Mailing Address - Country:US
Mailing Address - Phone:763-227-8846
Mailing Address - Fax:763-445-2501
Practice Address - Street 1:11670 FOUNTAINS DR STE 200
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7195
Practice Address - Country:US
Practice Address - Phone:763-227-8846
Practice Address - Fax:763-445-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1851953343OtherHOME HEALTH CARE