MEDICARE: DEPENDABLE HOME HEALTHCARE, INC

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	A797345400	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A797345400	OTHER	MN	MINNESOTA HEALTHCARE PROGRAMS

General Provider Information

NPI Number	:	1730466533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPENDABLE HOME HEALTHCARE, INC

Provider Business Mailing Address
First Line	:	2984 RICE ST
Second Line	:
City	:	LITTLE CANADA
State	:	MN
Zip	:	55113-2230
Country	:	US
Telephone Number	:	651-779-9810
Fax Number	:	651-779-9809

Provider Business Practice Location Address
First Line	:	2984 RICE ST
Second Line	:
City	:	LITTLE CANADA
State	:	MN
Zip	:	55113-2230
Country	:	US
Telephone Number	:	651-779-9810
Fax Number	:	651-779-9809

Authorized Official
Title or Position	:	ADMNISTRATOR
Name	:	MR. ISAAC KWESI MENSAH
Credential	:
Telephone Number	:	651-779-9810

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	11/08/2011

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