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Organization

SOURCE HEALTHCARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHRISTIAN O EZEOKEKE (OWNER)
(612) 281-3766
Entity
Organization

Contact information

Practice address
1513 BRYANT AVE N, MINNEAPOLIS, MN 55411-3258
(612) 281-3766
Mailing address
1513 BRYANT AVE N, MINNEAPOLIS, MN 55411-3258
(612) 281-3766

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary

Other

Enumeration date
07/07/2021
Last updated
07/07/2021
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