Healthcare Provider Details

I. General information

NPI: 1386450369
Provider Name (Legal Business Name): HAYU HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 HIGHWAY 36 W APT 124
ROSEVILLE MN
55113-4041
US

IV. Provider business mailing address

1690 HIGHWAY 36 W APT 124
ROSEVILLE MN
55113-4041
US

V. Phone/Fax

Practice location:
  • Phone: 612-404-7969
  • Fax:
Mailing address:
  • Phone: 612-404-7969
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GELMO ABRAHIM
Title or Position: CO-OWNER
Credential:
Phone: 612-404-7969