MEDICARE: ALPHA GROUP HOME 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1477230647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA GROUP HOME LLC

Provider Business Mailing Address
First Line	:	2915 WAYZATA BLVD STE 103
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2145
Country	:	US
Telephone Number	:	612-558-4384
Fax Number	:	612-486-7304

Provider Business Practice Location Address
First Line	:	2915 S WAYZATA BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2145
Country	:	US
Telephone Number	:	612-558-4384
Fax Number	:	612-486-7304

Authorized Official
Title or Position	:	OWNER
Name	:	ABDULKADIR ISMAIL JAMA
Credential	:
Telephone Number	:	612-558-4384

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	03/16/2025

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