MEDICARE: CAPITAL HEALTH SERVICES 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	1080424-1-HCBS	MN

General Provider Information

NPI Number	:	1609325620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	8441 WAYZATA BLVD STE 260
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55426-1376
Country	:	US
Telephone Number	:	651-795-1589
Fax Number	:	651-305-0259

Provider Business Practice Location Address
First Line	:	2700 SUMMER ST NE STE 2700B
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2820
Country	:	US
Telephone Number	:	651-795-1589
Fax Number	:	651-305-0259

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMED FARAH
Credential	:
Telephone Number	:	651-795-1589

Provider Enumeration Date	:	10/03/2016
Last Update Date	:	07/02/2018

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Directions to “CAPITAL HEALTH SERVICES LLC ” Practice Location

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