MEDICARE: ELEGANT SERVICES L.L.C

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	:	1093467920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEGANT SERVICES L.L.C

Provider Business Mailing Address
First Line	:	1405 SILVER LAKE RD NW STE 5
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9309
Country	:	US
Telephone Number	:	612-442-2008
Fax Number	:	612-808-2045

Provider Business Practice Location Address
First Line	:	1405 SILVER LAKE RD NW STE 5
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9309
Country	:	US
Telephone Number	:	612-442-2008
Fax Number	:	612-808-2045

Authorized Official
Title or Position	:	MANAGEMENT
Name	:	MR. YASSIN KHADAR MOHAMED
Credential	:
Telephone Number	:	612-442-2008

Provider Enumeration Date	:	01/21/2022
Last Update Date	:	11/24/2023

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