MEDICARE: EAGLE GROUP HOME

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	:	1326681511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE GROUP HOME

Provider Business Mailing Address
First Line	:	2104 PARK AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-6607
Country	:	US
Telephone Number	:	612-644-6127
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 PARK AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-6607
Country	:	US
Telephone Number	:	612-644-6127
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KHADIJA ABDIKARIM
Credential	:
Telephone Number	:	612-644-6127

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	10/21/2019

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