Provider Demographics
NPI:1063303568
Name:CHERUBIM HOME CARE LLC
Entity type:Organization
Organization Name:CHERUBIM HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOKAMBE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:248-790-5926
Mailing Address - Street 1:2318 W FALLCREEK CT
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5253
Mailing Address - Country:US
Mailing Address - Phone:248-790-5926
Mailing Address - Fax:
Practice Address - Street 1:2318 W FALLCREEK CT
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5253
Practice Address - Country:US
Practice Address - Phone:248-790-5926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant