Organization
SHOLOM COMMUNITY ALLIANCE HOME HEALTH CARE
Active
Other names
Sholom Hospice
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS WYCKOFF (CONTROLLER)
(952) 939-1637
Entity
Organization
Contact information
Practice address
3630 PHILLIPS PKWY, ST LOUIS PARK, MN 55426-3792
(952) 939-1515
(952) 933-1485
Mailing address
3630 PHILLIPS PKWY, ST LOUIS PARK, MN 55426-3792
(952) 939-1515
(952) 933-1485
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271243100
—
MN
Enumeration date
06/02/2008
Last updated
05/14/2019
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