MEDICARE: FRIENDS & FAMILY HOMECARE

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

General Provider Information

NPI Number	:	1447422183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDS & FAMILY HOMECARE

Provider Business Mailing Address
First Line	:	16720 73RD PL N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-2130
Country	:	US
Telephone Number	:	763-420-4005
Fax Number	:

Provider Business Practice Location Address
First Line	:	16720 73RD PL N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-2130
Country	:	US
Telephone Number	:	763-420-4005
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEREMY BENACKA
Credential	:
Telephone Number	:	763-420-4005

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	04/01/2008

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