MEDICARE: ADVANZED HOME HEALTH CARE 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	:	1811321540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANZED HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	3831 BAKKEN BLVD
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-5056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3831 BAKKEN BLVD
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-5056
Country	:	US
Telephone Number	:	612-323-0315
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	LIBAN MOHAMUD
Credential	:
Telephone Number	:	612-323-0315

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	12/11/2013

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