MEDICARE: BRAATEN HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1013231760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAATEN HEALTH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 3488
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52808-3488
Country	:	US
Telephone Number	:	563-327-0132
Fax Number	:	563-359-5642

Provider Business Practice Location Address
First Line	:	5403 VICTORIA AVE
Second Line	:	SUITE 20
City	:	DAVENPORT
State	:	IA
Zip	:	52807-3925
Country	:	US
Telephone Number	:	563-327-0132
Fax Number	:	563-359-5642

Authorized Official
Title or Position	:	BILLING/CLAIMS ANALYST
Name	:	MARCY A HULL
Credential	:
Telephone Number	:	563-327-0133

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	03/25/2010

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