=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275779522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMAD HOME HEALTH CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2008
-----------------------------------------------------
Last Update Date | 12/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 149 THOMPSON AVE E SUITE # 207
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55118-3238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-552-7764
-----------------------------------------------------
Fax | 651-552-9051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 149 THOMPSON AVE E SUITE # 207
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55118-3238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-552-7764
-----------------------------------------------------
Fax | 651-552-9051
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ASH FARAH II
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-552-7764
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HE-01084-04
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------