MEDICARE: EDELWEISS HOME HEALTH CARE

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	331449	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	331449	OTHER	MN	HOME CARE LICENSE

General Provider Information

NPI Number	:	1316956964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDELWEISS HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	7014 E FISH LAKE RD
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-2832
Country	:	US
Telephone Number	:	763-315-1050
Fax Number	:

Provider Business Practice Location Address
First Line	:	7014 E FISH LAKE RD
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-2832
Country	:	US
Telephone Number	:	763-315-1050
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. EDELGARD AUSTIN
Credential	:	RN
Telephone Number	:	763-315-1050

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/22/2020

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