MEDICARE: QUALITY GROUP HOMES, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1629789680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY GROUP HOMES, LLC

Provider Business Mailing Address
First Line	:	1144 36 1/2 AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-1303
Country	:	US
Telephone Number	:	612-446-5217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1144 36 1/2 AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-1303
Country	:	US
Telephone Number	:	612-446-5217
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	HUSSEIN ABDI WARSAME
Credential	:
Telephone Number	:	612-446-5217

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/12/2022

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