=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316302581
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORE HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2015
-----------------------------------------------------
Last Update Date | 03/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 E 146TH ST STE 230
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-6757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-432-1492
-----------------------------------------------------
Fax | 952-432-0873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1020 E 146TH ST STE 230
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-6757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-432-1492
-----------------------------------------------------
Fax | 952-432-0873
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | MR. ALI KHALIF WARSAME
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 952-200-8791
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------