Individual
MR. TIMOTHY ANTON KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7954 BROOKLYN BOULAVARD, 7954, BROOKLYN PARK, MN 55445
(952) 210-2131
Mailing address
7954 BROOKLYN BOULAVARD, 7954, BROOKLYN PARK, MN 55445
(952) 210-2131
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
1536744
MN
251E00000X
Home Health Agency
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27-2211896
HOMECARE
MN
01
—
621610
HOMECARE
MN
Enumeration date
04/01/2010
Last updated
04/01/2010
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