MEDICARE: B.A COMFORT LIFE HOMECARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency
4	310500000X	Mental Illness Intermediate Care Facility
5	3104A0630X	Assisted Living Facility (Behavioral Disturbances)
6	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1215577960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B.A COMFORT LIFE HOMECARE LLC

Provider Business Mailing Address
First Line	:	3300 COUNTY ROAD 10 STE 204F
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3072
Country	:	US
Telephone Number	:	612-226-5905
Fax Number	:

Provider Business Practice Location Address
First Line	:	4325 83RD CIR N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-2550
Country	:	US
Telephone Number	:	612-226-5905
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MR. JOSHUA FRANK ABUKI
Credential	:
Telephone Number	:	612-226-5905

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	01/10/2020

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