MEDICARE: 24 - SEVEN HOME CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251J00000X	Nursing Care Agency
2	251S00000X	Community/Behavioral Health Agency
3	253Z00000X	In Home Supportive Care Agency
4	311ZA0620X	Adult Care Home Facility
5	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
6	385H00000X	Respite Care
7	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1467916205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	24 - SEVEN HOME CARE INC

Provider Business Mailing Address
First Line	:	7111 W BROADWAY AVE STE 202D
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-1692
Country	:	US
Telephone Number	:	612-886-2828
Fax Number	:	612-886-2861

Provider Business Practice Location Address
First Line	:	7111 W BROADWAY AVE STE 202D
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-1692
Country	:	US
Telephone Number	:	612-886-2828
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	OVIE AVWENAGHAGHA
Credential	:
Telephone Number	:	612-886-2828

Provider Enumeration Date	:	01/25/2019
Last Update Date	:	01/26/2019

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