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General NPI Number Information
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NPI Number | 1932384666
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Entity Type | Organization
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Legal Business Name | PRO-HEALTH CARE, INC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 4710 CENTRAL AVE NE
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City | COLUMBIA HEIGHTS
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State | MN
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Zip | 55421-1944
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Country | US
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Telephone | 763-746-8155
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Fax | 763-746-8154
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Provider Business Mailing Address
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Address Line | 4710 CENTRAL AVE NE
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City | COLUMBIA HEIGHTS
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State | MN
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Zip | 55421-1944
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Country | US
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Telephone | 763-746-8155
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Fax | 763-746-8154
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. ABDULWAHAB ASAMARAI
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Credential | M.D., PH.D.
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Telephone | 763-746-8155
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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 | 335929
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License Number State | MN
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