Organization
SHOLOM COMMUNITY ALLIANCE HOME HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS WYCKOFF (CONTROLLER)
(952) 939-1637
Entity
Organization
Contact information
Practice address
3620 PHILLIPS PARKWAY, ST LOUIS PARK, MN 55426-3700
(952) 935-6311
(952) 935-2701
Mailing address
3620 PHILLIPS PARKWAY, ST LOUIS PARK, MN 55426-3700
(952) 935-6311
(952) 935-2701
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181119
EVERCARE UCARE
—
05
—
271243100
—
MN
01
—
4980928
EVERCARE MEDICA
—
Enumeration date
03/15/2006
Last updated
05/14/2019
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