MEDICARE: ABC HOME HEALTH 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1144967761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC HOME HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	3055 OLD HIGHWAY 8 STE 111
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-2577
Country	:	US
Telephone Number	:	612-326-9377
Fax Number	:	612-326-1206

Provider Business Practice Location Address
First Line	:	3055 OLD HIGHWAY 8 STE 111
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-2577
Country	:	US
Telephone Number	:	612-326-9377
Fax Number	:	612-326-1206

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ADAN Y DIRIE
Credential	:
Telephone Number	:	612-326-9377

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/16/2022

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