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Organization
PROVENANCE HOMES
Active
Organization
PROVENANCE HOMES
Active
Parent organization
PROVENANCE HEALTHCARE STAFFING LLC
Other names
Provenance Homes
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVENANCE HEALTHCARE STAFFING LLC
Authorized official
SABRINA LUKALU GLOBUS (OWNER)
(612) 741-7311
Entity
Organization
Contact information
Practice address
1650 W END BLVD STE 100, ST LOUIS PARK, MN 55416-5369
(612) 261-6988
(612) 465-1402
Mailing address
1650 W END BLVD STE 100, ST LOUIS PARK, MN 55416-5369
(612) 261-6988
(612) 465-1402
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
Other
Enumeration date
08/31/2023
Last updated
10/31/2023
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