MEDICARE: PRECIOUS PARTNERS 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	:	1699236737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECIOUS PARTNERS HOMECARE LLC

Provider Business Mailing Address
First Line	:	2340 132ND LN NW
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55448-2570
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 132ND LN NW
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55448-2570
Country	:	US
Telephone Number	:	763-447-5873
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	FAIMATA FOFANA
Credential	:
Telephone Number	:	646-420-3736

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	03/29/2019

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