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NPI Code Detail

MEDICARE: ANGELS OF MERCY HOMECARE SERVICES; INC.

MEDICARE: ANGELS OF MERCY HOMECARE SERVICES; 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
1314000000XSkilled Nursing Facility340801MN
2251E00000XHome Health Agency340166MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2A432120000OTHERMNMHCP UMP

General Provider Information

NPI Number : 1396980793
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANGELS OF MERCY HOMECARE SERVICES; INC.
Provider Business Mailing Address
First Line : 6018 HALIFAX PL
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55429-2440
Country : US
Telephone Number : 763-432-9706
Fax Number : 763-432-9708
Provider Business Practice Location Address
First Line : 6018 HALIFAX PL
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55429-2440
Country : US
Telephone Number : 763-432-9706
Fax Number : 763-432-9708
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. FOLUSO AYOTUNKU ALLISON
Credential :
Telephone Number : 763-432-9706
Provider Enumeration Date : 12/13/2008
Last Update Date : 12/13/2008

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Directions to “ANGELS OF MERCY HOMECARE SERVICES; INC. ” Practice Location

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