MEDICARE: NWEAGE HOMECARE

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	655813100025	MN

General Provider Information

NPI Number	:	1295167203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NWEAGE HOMECARE

Provider Business Mailing Address
First Line	:	6812 SCOTT AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1666
Country	:	US
Telephone Number	:	763-300-9040
Fax Number	:

Provider Business Practice Location Address
First Line	:	6812 SCOTT AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-1666
Country	:	US
Telephone Number	:	763-300-9040
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LANKIA LARTEY
Credential	:
Telephone Number	:	763-300-9040

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	07/31/2013

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Directions to “NWEAGE HOMECARE ” Practice Location

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