Redemption Pca Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

REDEMPTION PCA SERVICES LLC

Practice address

6000 Bass Lake Rd Ste 120
Crystal, MN 55429-2768

Phone

(763) 406-0577

NPI assigned

Jul 6, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Samon Dawon Bahtuoh

Title

Ceo

Phone

(763) 406-0577

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688601600000",
    "number": "1407534886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 BASS LAKE RD STE 120",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554292768",
            "telephone_number": "763-406-0577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 BASS LAKE RD STE 120",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554292768",
            "telephone_number": "763-406-0577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDEMPTION PCA SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-06",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A",
        "authorized_official_last_name": "BAHTUOH",
        "authorized_official_first_name": "SAMON",
        "authorized_official_middle_name": "DAWON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-406-0577",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.