MEDICARE: AUDRIE HOME HEALTH CARE 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

General Provider Information

NPI Number	:	1417197724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDRIE HOME HEALTH CARE LLC.

Provider Business Mailing Address
First Line	:	7040 LAKELAND AVE N
Second Line	:	STE. 205
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-5600
Country	:	US
Telephone Number	:	763-560-9212
Fax Number	:	763-560-9636

Provider Business Practice Location Address
First Line	:	7040 LAKELAND AVE N
Second Line	:	STE. 205
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-5600
Country	:	US
Telephone Number	:	763-560-9212
Fax Number	:	763-560-9636

Authorized Official
Title or Position	:	OWNER
Name	:	MS. AUDREY MARIE PIERSON
Credential	:
Telephone Number	:	763-560-9212

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	04/29/2011

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