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General NPI Number Information
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NPI Number | 1013510510
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Entity Type | Organization
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Legal Business Name | MISSION HOME HEALTHCARE LLC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 1013 CLIFF RD E STE 301
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City | BURNSVILLE
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State | MN
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Zip | 55337-1540
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Country | US
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Telephone | 612-735-9711
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Fax |
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Provider Business Mailing Address
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Address Line | 1808 UNIVERSITY AVE NE APT 121
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-4332
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Country | US
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Telephone | 612-735-9711
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ABSHIR MOHAMUD
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Credential |
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Telephone | 612-735-9711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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