MEDICARE: ADVANCED 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
2	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	389245	OTHER	MN	COMPREHENSIVE HOME CARELLC

General Provider Information

NPI Number	:	1356806541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	4201 MAIN ST NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-2767
Country	:	US
Telephone Number	:	763-438-6764
Fax Number	:	612-486-8841

Provider Business Practice Location Address
First Line	:	4201 MAIN ST NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-2767
Country	:	US
Telephone Number	:	763-438-6764
Fax Number	:	612-486-8841

Authorized Official
Title or Position	:	OWNER
Name	:	ABDIFATAH DIRIE
Credential	:
Telephone Number	:	763-438-6764

Provider Enumeration Date	:	02/01/2019
Last Update Date	:	02/01/2019

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Directions to “ADVANCED HOME HEALTH CARE LLC ” Practice Location

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