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NPI Code Detail

MEDICARE: HENNEPIN HOME HEALTH CARE, INC.

MEDICARE: HENNEPIN HOME HEALTH 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
1251E00000XHome Health Agency328275MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275523953
Entity Type Code : Organization
Provider Name (Legal Business Name) : HENNEPIN HOME HEALTH CARE, INC.
Provider Business Mailing Address
First Line : 8590 EDINBURGH CENTER DR
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-3723
Country : US
Telephone Number : 763-425-5959
Fax Number : 763-425-5929
Provider Business Practice Location Address
First Line : 8590 EDINBURGH CENTER DR
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-3723
Country : US
Telephone Number : 763-425-5959
Fax Number : 763-425-5929
Authorized Official
Title or Position : PRESIDENT/ADMINISTRATOR
Name : MS. AMELIA MATA
Credential :
Telephone Number : 763-425-5959
Provider Enumeration Date : 10/25/2005
Last Update Date : 10/27/2015

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