MEDICARE: GREENERY HOME CARE LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1306617550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENERY HOME CARE LLC

Provider Business Mailing Address
First Line	:	1842 CENTRAL AVE NE STE 1
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-4541
Country	:	US
Telephone Number	:	763-647-4040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1842 CENTRAL AVE NE STE 1
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-4541
Country	:	US
Telephone Number	:	763-647-4040
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABDIFATAH MOHAMED
Credential	:
Telephone Number	:	763-647-4040

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	01/15/2024

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Directions to “GREENERY HOME CARE LLC ” Practice Location

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