# PROVENANCE HOMES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVENANCE HEALTHCARE STAFFING LLC
- **Other names:** Provenance Homes
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1285410746
- **Legal business name:** PROVENANCE HEALTHCARE STAFFING LLC
- **Authorized official:** SABRINA LUKALU GLOBUS (OWNER)
- **Authorized official phone:** (612) 741-7311

## Contact information

- **Practice address:** 1650 W END BLVD STE 100, ST LOUIS PARK, MN 55416-5369
- **Practice address phone:** (612) 261-6988
- **Practice address fax:** (612) 465-1402
- **Mailing address:** 1650 W END BLVD STE 100, ST LOUIS PARK, MN 55416-5369
- **Mailing address phone:** (612) 261-6988
- **Mailing address fax:** (612) 465-1402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 08/31/2023
- **Last updated:** 10/31/2023