Healthcare Provider Details

I. General information

NPI: 1942609425
Provider Name (Legal Business Name): AMERICAN HOME HEALTH AIDE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 NICOLS RD SUITE 205
EAGAN MN
55122-3336
US

IV. Provider business mailing address

4651 NICOLS RD SUITE 205
EAGAN MN
55122-3336
US

V. Phone/Fax

Practice location:
  • Phone: 651-452-2287
  • Fax: 651-454-8328
Mailing address:
  • Phone: 651-452-2287
  • Fax: 651-454-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number367586
License Number StateMN

VIII. Authorized Official

Name: SHERWA NUR
Title or Position: OWNER
Credential:
Phone: 651-452-2287