MEDICARE: MINNIE 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	HC3443	NC

General Provider Information

NPI Number	:	1437507563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNIE INC

Provider Business Mailing Address
First Line	:	3761 JUNCTION BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-5263
Country	:	US
Telephone Number	:	919-542-2520
Fax Number	:	919-545-5540

Provider Business Practice Location Address
First Line	:	3761 JUNCTION BLVD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-5263
Country	:	US
Telephone Number	:	919-542-2520
Fax Number	:	919-545-5540

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN D LAKE
Credential	:
Telephone Number	:	919-542-2520

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	05/31/2016

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