MEDICARE: QUALITY ASSURANCE HOME HEALTH OF MINNESOTA

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	:	1053620401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY ASSURANCE HOME HEALTH OF MINNESOTA

Provider Business Mailing Address
First Line	:	5353 WAYZATA BLVD
Second Line	:	STE 204
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1340
Country	:	US
Telephone Number	:	952-500-9113
Fax Number	:	952-303-3361

Provider Business Practice Location Address
First Line	:	5353 WAYZATA BLVD
Second Line	:	STE 204
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1340
Country	:	US
Telephone Number	:	952-500-9113
Fax Number	:	952-303-3361

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. JAMES ARYEETEY
Credential	:
Telephone Number	:	952-500-9113

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	10/04/2010

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