MEDICARE: COMPLETE HOME 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

General Provider Information

NPI Number	:	1669646816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE HOME HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	3616 ROOSEVELT ST NE
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-1559
Country	:	US
Telephone Number	:	612-788-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	3616 ROOSEVELT ST NE
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-1559
Country	:	US
Telephone Number	:	612-788-2273
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	SIRRI A NOMO-ONGOLO
Credential	:
Telephone Number	:	612-788-2273

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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