MEDICARE: AG HOME HEALTH CARE, 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

General Provider Information

NPI Number	:	1619651957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AG HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	15831 GRIFFON PATH
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-6661
Country	:	US
Telephone Number	:	651-370-8055
Fax Number	:

Provider Business Practice Location Address
First Line	:	20765 HOLYOKE AVE
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-9825
Country	:	US
Telephone Number	:	651-615-4148
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANAB ADAN GULAID
Credential	:	MPA
Telephone Number	:	651-370-8055

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	08/10/2025

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