Provider Demographics
NPI:1215440763
Name:MINN CARE HOME HEALTH
Entity type:Organization
Organization Name:MINN CARE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IKENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIJEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-200-6270
Mailing Address - Street 1:151 SILVER LAKE RD NW UNIT 201
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-8108
Mailing Address - Country:US
Mailing Address - Phone:763-200-6270
Mailing Address - Fax:763-201-7908
Practice Address - Street 1:151 SILVER LAKE RD NW UNIT 2
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-8101
Practice Address - Country:US
Practice Address - Phone:763-200-6270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health