MEDICARE: PRO-HEALTH CARE, INC

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	:	1174748263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO-HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	3989 CENTRAL AVE NE
Second Line	:	SUITE 510
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3900
Country	:	US
Telephone Number	:	763-746-8155
Fax Number	:	763-746-8154

Provider Business Practice Location Address
First Line	:	3989 CENTRAL AVE NE
Second Line	:	SUITE 510
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3900
Country	:	US
Telephone Number	:	763-746-8155
Fax Number	:	763-746-8154

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DR. ABDULWAHAB M. ASAMARAI
Credential	:	M.D., PH.D.
Telephone Number	:	763-746-8155

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	11/06/2009

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