Provider Demographics
NPI:1366163164
Name:KATE DEES HOMECARE LLC
Entity type:Organization
Organization Name:KATE DEES HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-781-7844
Mailing Address - Street 1:2366 55TH ST S APT 206
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7625
Mailing Address - Country:US
Mailing Address - Phone:312-404-8184
Mailing Address - Fax:
Practice Address - Street 1:2366 55TH ST S APT 206
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7625
Practice Address - Country:US
Practice Address - Phone:312-404-8184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0005879966Medicaid