Individual
LATASHA KILGORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1313 LOGAN AVE N, MINNEAPOLIS, MN 55411-3169
(612) 999-0908
Mailing address
1313 LOGAN AVE N, MINNEAPOLIS, MN 55411-3169
(612) 999-0908
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
310400000X
Assisted Living Facility
Primary
—
—
376G00000X
Nursing Home Administrator
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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