MEDICARE: LADY TEES HOME CARE SVCS 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	338321	MN

General Provider Information

NPI Number	:	1568635159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LADY TEES HOME CARE SVCS INC

Provider Business Mailing Address
First Line	:	4727 WINGARD LANE
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1230
Country	:	US
Telephone Number	:	763-438-0009
Fax Number	:	763-515-0431

Provider Business Practice Location Address
First Line	:	4727 WINGARD LANE
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1230
Country	:	US
Telephone Number	:	763-438-0009
Fax Number	:	763-515-0431

Authorized Official
Title or Position	:	CEO
Name	:	MRS. TENNEH LEBBI JOHNSON
Credential	:	LPN
Telephone Number	:	763-438-0009

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	04/04/2008

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