MEDICARE: HEALTHMAX HOME HEALTH CARE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A774407200	OTHER	MN	UMPI
2	A270085300	OTHER	MN	UMPI
3	A563900000	OTHER	MN	UMPI
4	A436930000	OTHER	MN	UMPI
5	A667920400	OTHER	MN	UMPI

General Provider Information

NPI Number	:	1669004495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHMAX HOME HEALTH CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	125 W BROADWAY AVE STE 102B
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-2246
Country	:	US
Telephone Number	:	612-521-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 W BROADWAY AVE STE 102B
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-2246
Country	:	US
Telephone Number	:	612-521-2400
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	AIMEE BOYD HULSING
Credential	:
Telephone Number	:	763-575-8046

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	02/10/2020

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