MEDICARE: U-SPAN SERVICES

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	ER3445	MN

General Provider Information

NPI Number	:	1699902353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U-SPAN SERVICES

Provider Business Mailing Address
First Line	:	5637 BROOKLYN BLVD STE 200C
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3061
Country	:	US
Telephone Number	:	612-235-3060
Fax Number	:

Provider Business Practice Location Address
First Line	:	5637 BROOKLYN BLVD
Second Line	:	SUITE 200C
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3061
Country	:	US
Telephone Number	:	612-235-3060
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JOHNNY J OPIAMENSAH
Credential	:
Telephone Number	:	612-235-3060

Provider Enumeration Date	:	06/19/2009
Last Update Date	:	06/19/2009

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Directions to “U-SPAN SERVICES ” Practice Location

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