Provider Demographics
NPI:1053194357
Name:LIVE IN CARE HOME HEALTH LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:LIVE IN CARE HOME HEALTH LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEOKHONMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHOMSOUKHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-843-5996
Mailing Address - Street 1:7839 85TH CT N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2156
Mailing Address - Country:US
Mailing Address - Phone:763-843-5996
Mailing Address - Fax:
Practice Address - Street 1:8625 CHEROKEE DR N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1916
Practice Address - Country:US
Practice Address - Phone:763-843-5996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility