MEDICARE: ANGELICARE 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	251E00000X	Home Health Agency	343034	MN

General Provider Information

NPI Number	:	1376870410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELICARE LLC

Provider Business Mailing Address
First Line	:	5871 CEDAR LAKE RD.
Second Line	:	SUITE 101
City	:	ST. LOUIS PARK
State	:	MN
Zip	:	55416-1478
Country	:	US
Telephone Number	:	952-544-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	5871 CEDAR LAKE RD S
Second Line	:	SUITE 101
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-1472
Country	:	US
Telephone Number	:	952-544-6300
Fax Number	:

Authorized Official
Title or Position	:	LLC MEMBER
Name	:	MR. RONALD E. HAGBERG
Credential	:
Telephone Number	:	952-544-6300

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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