Provider Demographics
NPI:1174130777
Name:HUMBLE HOME CHORE SERVICE LLC
Entity type:Organization
Organization Name:HUMBLE HOME CHORE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELAVOIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-312-7409
Mailing Address - Street 1:940 E BROOKE PL
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-2439
Mailing Address - Country:US
Mailing Address - Phone:763-312-7409
Mailing Address - Fax:763-312-2037
Practice Address - Street 1:6120 EARLE BROWN DR STE 230
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-4107
Practice Address - Country:US
Practice Address - Phone:763-401-1792
Practice Address - Fax:763-312-2037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA127960000OtherUNPI