MEDICARE: BROTHERS HOME CARE 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	:	1174113088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROTHERS HOME CARE LLC

Provider Business Mailing Address
First Line	:	2246 129TH LN NW
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55448-7084
Country	:	US
Telephone Number	:	616-514-8845
Fax Number	:

Provider Business Practice Location Address
First Line	:	2246 129TH LN NW
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55448-7084
Country	:	US
Telephone Number	:	616-514-8845
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ANWAR ISSE
Credential	:
Telephone Number	:	616-514-8845

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	01/25/2021

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