MEDICARE: SAFINA HOME HEALTH CARE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3747P1801X	OTHER	MN	HOME HEALTH AGENCY

General Provider Information

NPI Number	:	1043726748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFINA HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	3400 1ST ST N STE 303
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-1927
Country	:	US
Telephone Number	:	320-774-2142
Fax Number	:	320-774-2143

Provider Business Practice Location Address
First Line	:	3400 1ST ST N STE 303
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-1927
Country	:	US
Telephone Number	:	320-774-2142
Fax Number	:	320-774-2143

Authorized Official
Title or Position	:	OWNER
Name	:	AHMED M JAMA
Credential	:
Telephone Number	:	773-664-2385

Provider Enumeration Date	:	12/18/2017
Last Update Date	:	08/15/2019

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