MEDICARE: AZIZAS RESIDENTIAL 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1437966314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZIZAS RESIDENTIAL CARE LLC

Provider Business Mailing Address
First Line	:	126 W CHANNING AVE
Second Line	:
City	:	FERGUS FALLS
State	:	MN
Zip	:	56537-2729
Country	:	US
Telephone Number	:	701-793-8385
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 39TH ST S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-7401
Country	:	US
Telephone Number	:	701-793-8385
Fax Number	:

Authorized Official
Title or Position	:	MANGER
Name	:	CALVIN SAIE
Credential	:
Telephone Number	:	701-793-8385

Provider Enumeration Date	:	12/14/2024
Last Update Date	:	12/19/2024

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Directions to “AZIZAS RESIDENTIAL CARE LLC ” Practice Location

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