MEDICARE: ACCOUNTABLE HOME CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1114404829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCOUNTABLE HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	19485 BOSTON ST NW
Second Line	:
City	:	ELK RIVER
State	:	MN
Zip	:	55330-4121
Country	:	US
Telephone Number	:	612-387-6629
Fax Number	:	763-276-1206

Provider Business Practice Location Address
First Line	:	19485 BOSTON ST NW
Second Line	:
City	:	ELK RIVER
State	:	MN
Zip	:	55330-4121
Country	:	US
Telephone Number	:	612-387-6629
Fax Number	:	763-276-1206

Authorized Official
Title or Position	:	CEO
Name	:	PERKALOAH AMANDA QUEEGLAY-TARPEH
Credential	:	REGISTERED NURSE
Telephone Number	:	612-387-6629

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	05/24/2020

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