Provider Demographics
NPI:1760189930
Name:NEW DYNAMIC HOME CARE LLC
Entity type:Organization
Organization Name:NEW DYNAMIC HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-245-1730
Mailing Address - Street 1:5821 CEDAR LAKE RD S RM 108
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1487
Mailing Address - Country:US
Mailing Address - Phone:763-245-1730
Mailing Address - Fax:
Practice Address - Street 1:5821 CEDAR LAKE RD S RM 108
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1487
Practice Address - Country:US
Practice Address - Phone:763-245-1730
Practice Address - Fax:763-226-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health