=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972994069
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONVENIENCE HOME HEALTH CARE AIDE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2015
-----------------------------------------------------
Last Update Date | 02/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 4TH AVE S SUITE100
-----------------------------------------------------
City | MOORHEAD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56560-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-636-3593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 4TH AVE S SUITE100
-----------------------------------------------------
City | MOORHEAD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56560-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. OMAR MOHAMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-636-3593
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------