MEDICARE: RISING LEGACY HOME HEALTH LLC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	376J00000X	Homemaker
2	376K00000X	Nurse's Aide
3	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1194682682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING LEGACY HOME HEALTH LLC.

Provider Business Mailing Address
First Line	:	4740 42ND AVE N STE 206
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-1828
Country	:	US
Telephone Number	:	763-381-7886
Fax Number	:

Provider Business Practice Location Address
First Line	:	4740 42ND AVE N STE 206
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-1828
Country	:	US
Telephone Number	:	763-381-7886
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASIA NICOLE FORREST
Credential	:
Telephone Number	:	763-381-7886

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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