MEDICARE: ASSURED HOMES, 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	364678	MN

General Provider Information

NPI Number	:	1376966655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSURED HOMES, LLC

Provider Business Mailing Address
First Line	:	8650 TESSMAN CIR N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-3101
Country	:	US
Telephone Number	:	612-306-7293
Fax Number	:	888-215-5070

Provider Business Practice Location Address
First Line	:	8650 TESSMAN CIR N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-3101
Country	:	US
Telephone Number	:	612-306-7293
Fax Number	:	888-215-5070

Authorized Official
Title or Position	:	COO
Name	:	MR. AMOS S OMBITO
Credential	:
Telephone Number	:	612-306-7293

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	01/22/2014

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