MEDICARE: ELEGED HOME CARE INC

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	:	1275172504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEGED HOME CARE INC

Provider Business Mailing Address
First Line	:	2824 OAKLAND AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1302
Country	:	US
Telephone Number	:	612-800-3105
Fax Number	:	612-435-2770

Provider Business Practice Location Address
First Line	:	2824 OAKLAND AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1302
Country	:	US
Telephone Number	:	612-800-3105
Fax Number	:	612-435-2770

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	ABDI HUSSEIN ALI
Credential	:	RESPIRATORY THERAPIS
Telephone Number	:	612-558-6280

Provider Enumeration Date	:	01/03/2020
Last Update Date	:	09/30/2020

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