MEDICARE: RAGAAD HOME HEALTH CARE CO

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
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1194364521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAGAAD HOME HEALTH CARE CO

Provider Business Mailing Address
First Line	:	2509 12TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4504
Country	:	US
Telephone Number	:	612-442-4305
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 CENTRAL AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-3710
Country	:	US
Telephone Number	:	612-442-4305
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. YASIN FATAH
Credential	:
Telephone Number	:	612-442-4305

Provider Enumeration Date	:	01/02/2020
Last Update Date	:	11/14/2020

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