MEDICARE: HOME CARE MINNESOTA, INC.

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	:	1518456755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME CARE MINNESOTA, INC.

Provider Business Mailing Address
First Line	:	2800 FREEWAY BLVD STE 201
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	612-716-5138
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 FREEWAY BLVD STE 201
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	612-716-5138
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	CHOU THOR
Credential	:
Telephone Number	:	612-716-5137

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	05/03/2018

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