MEDICARE: DARYEEL HOMECARE 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	:	1639698178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARYEEL HOMECARE LLC

Provider Business Mailing Address
First Line	:	1106 COUNTY ROAD D W APT 23
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-7583
Country	:	US
Telephone Number	:	602-323-4873
Fax Number	:

Provider Business Practice Location Address
First Line	:	2931 E LAKE ST STE 203
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2691
Country	:	US
Telephone Number	:	602-323-4873
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABDIRAZAQ MOHAMED IBRAHIM
Credential	:
Telephone Number	:	602-323-4873

Provider Enumeration Date	:	09/15/2017
Last Update Date	:	07/21/2022

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