Healthcare Provider Details

I. General information

NPI: 1205589272
Provider Name (Legal Business Name): AXIS HOME PCA AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 FREMONT AVE S
MINNEAPOLIS MN
55405-2648
US

IV. Provider business mailing address

2417 FREMONT AVE S
MINNEAPOLIS MN
55405-2648
US

V. Phone/Fax

Practice location:
  • Phone: 612-354-7714
  • Fax:
Mailing address:
  • Phone: 612-354-7714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CUBTAN NUR
Title or Position: OWNER
Credential:
Phone: 612-354-7714