MEDICARE: FIRST SERVICES FOR SENIORS, 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		MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25	OTHER	MN	BOTH PCA CHOICE AND PCPO

General Provider Information

NPI Number	:	1427214584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST SERVICES FOR SENIORS, LLC

Provider Business Mailing Address
First Line	:	1201 E LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407
Country	:	US
Telephone Number	:	612-709-1440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2413 CHICAGO AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407
Country	:	US
Telephone Number	:	612-709-1440
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. ABSHIR ALI MOHAMED
Credential	:
Telephone Number	:	612-709-1440

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/29/2008

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