# COON RAPIDS HOME CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912658246
- **Authorized official:** IVAN MUHIDINE (VP)
- **Authorized official phone:** (612) 770-8226

## Contact information

- **Practice address:** 199 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-5831
- **Practice address phone:** (612) 770-8226
- **Mailing address:** PO BOX 490246, BLAINE, MN 55449-0246
- **Mailing address phone:** (612) 770-8226

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |
| 3747P1801X | Personal Care Attendant | — | NULL | — |
| 3747P1801X | Personal Care Attendant | — | — | — |

## Other

- **Enumeration date:** 01/18/2022
- **Last updated:** 01/18/2022