=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841363330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHIFFO HOME HEALTH CARE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 ELTON HILLS DR NW SUITE # 207
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-3516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-289-5801
-----------------------------------------------------
Fax | 507-289-5885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 ELTON HILLS DR NW SUITE # 207
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-3516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-289-5801
-----------------------------------------------------
Fax | 507-289-5885
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. HAMDI DAHIR ADEN
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 507-289-5801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 330591
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------