MEDICARE: BIG BROTHERS 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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104125251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG BROTHERS HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	2499 RICE ST
Second Line	:	SUITE 132
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-3724
Country	:	US
Telephone Number	:	651-494-9058
Fax Number	:	651-494-6680

Provider Business Practice Location Address
First Line	:	2499 RICE ST
Second Line	:	SUITE 132
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-3724
Country	:	US
Telephone Number	:	651-494-9058
Fax Number	:	651-494-6680

Authorized Official
Title or Position	:	CEO
Name	:	POU LY
Credential	:
Telephone Number	:	651-494-9058

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	03/15/2011

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