MEDICARE: ANOKA PROFESSIONAL HH 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
1	251E00000X	Home Health Agency	835147300038	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M243628700	OTHER	MN	UMPI
2	A642915100	OTHER	MN	UMPI

General Provider Information

NPI Number	:	1336583582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANOKA PROFESSIONAL HH INC

Provider Business Mailing Address
First Line	:	4211 CENTRAL AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-2921
Country	:	US
Telephone Number	:	763-754-4885
Fax Number	:	763-754-1023

Provider Business Practice Location Address
First Line	:	4211 CENTRAL AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421
Country	:	US
Telephone Number	:	763-754-4885
Fax Number	:	763-754-1023

Authorized Official
Title or Position	:	CEO
Name	:	JEMAL YUSUF
Credential	:
Telephone Number	:	763-754-4885

Provider Enumeration Date	:	04/18/2013
Last Update Date	:	07/09/2018

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