MEDICARE: NORTHWEST HOME HEALTH CARE SERVICES, 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	376J00000X	Homemaker
2	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	343G2NO	OTHER	MN	BLUECROSS/BLUESHIELD OF MN

General Provider Information

NPI Number	:	1346796182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST HOME HEALTH CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	1487 GOODWIN AVE. N.
Second Line	:
City	:	OAKDALE
State	:	MN
Zip	:	55128-5701
Country	:	US
Telephone Number	:	651-493-3834
Fax Number	:	651-493-3835

Provider Business Practice Location Address
First Line	:	1821 UNIVERSITY AVE W STE S348
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2876
Country	:	US
Telephone Number	:	651-493-3834
Fax Number	:	651-493-3835

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SYLVESTER KOKU AMELETSE
Credential	:
Telephone Number	:	651-493-3834

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	12/05/2025

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