MEDICARE: NOBILITY HOME HEALTH CARE 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	302R00000X	Health Maintenance Organization

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M750025100	OTHER	MN	MA - MEDICAL ASSISTANCE (MINNESOTA DHS ISSUED)

General Provider Information

NPI Number	:	1801212592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOBILITY HOME HEALTH CARE INC

Provider Business Mailing Address
First Line	:	1200 W BROADWAY AVE
Second Line	:	SUITE 130
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-2572
Country	:	US
Telephone Number	:	612-529-4646
Fax Number	:	612-587-2699

Provider Business Practice Location Address
First Line	:	1200 W BROADWAY AVE
Second Line	:	SUITE 130
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-2572
Country	:	US
Telephone Number	:	612-529-4646
Fax Number	:	612-587-2699

Authorized Official
Title or Position	:	CEO
Name	:	MR. ABDULREHMAN SHECK HASSAN
Credential	:
Telephone Number	:	612-529-4646

Provider Enumeration Date	:	03/05/2014
Last Update Date	:	03/05/2014

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Directions to “NOBILITY HOME HEALTH CARE INC ” Practice Location

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