Healthcare Provider Details

I. General information

NPI: 1144967761
Provider Name (Legal Business Name): ABC HOME HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 OLD HIGHWAY 8 STE 111
ST ANTHONY MN
55418-2577
US

IV. Provider business mailing address

3055 OLD HIGHWAY 8 STE 111
ST ANTHONY MN
55418-2577
US

V. Phone/Fax

Practice location:
  • Phone: 612-326-9377
  • Fax: 612-326-1206
Mailing address:
  • Phone: 612-326-9377
  • Fax: 612-326-1206

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: ADAN Y DIRIE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 612-326-9377