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NPI Code Detail

MEDICARE: PENNEH ISSIE HOME HEALTHCARE

MEDICARE: PENNEH ISSIE HOME HEALTHCARE
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
1364SH0200XHome Health Clinical Nurse Specialist
2374U00000XHome Health Aide

General Provider Information

NPI Number : 1194677708
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENNEH ISSIE HOME HEALTHCARE
Provider Business Mailing Address
First Line : 19141 JOHNSON ST NW
Second Line :
City : ELK RIVER
State : MN
Zip : 55330-7088
Country : US
Telephone Number : 763-321-0809
Fax Number :
Provider Business Practice Location Address
First Line : 19141 JOHNSON ST NW
Second Line :
City : ELK RIVER
State : MN
Zip : 55330-7088
Country : US
Telephone Number : 763-321-0809
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : MR. ANTHONY J KABA
Credential :
Telephone Number : 763-321-0809
Provider Enumeration Date : 02/14/2026
Last Update Date : 02/14/2026

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Directions to “PENNEH ISSIE HOME HEALTHCARE ” Practice Location

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