NPI 1902953474

Illiuminated Home Health Care LLC.

Organisation Preferred Provider Organization Saint Paul, MN

Practice location

Address: 175 Charles Ave 328, Saint Paul, MN 55103-2054
Phone: (952) 261-9935
Fax: (651) 224-2857
Mailing address: 175 Charles Avenue 328, St. Paul, MN 55103

Authorised official

Name: William B. Davis
Title: President
Phone: (952) 261-9935

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 904066000 (MN)

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Registry record

NPI: 1902953474
Entity type: Organization
NPI issued: 5 Jan 2007
Record last updated: 24 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.