Healthcare Provider Details

I. General information

NPI: 1548036296
Provider Name (Legal Business Name): HARRA HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10743 RHODE ISLAND AVE N
BROOKLYN PARK MN
55445
US

IV. Provider business mailing address

10743 RHODE ISLAND AVE N
BROOKLYN PARK MN
55445
US

V. Phone/Fax

Practice location:
  • Phone: 763-228-0912
  • Fax:
Mailing address:
  • Phone: 763-228-0912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROSE M AHMED
Title or Position: DIRECTOR OF NURSING
Credential: RN, BSN, CRRP
Phone: 763-228-0912