MEDICARE: MANDEEQ HOME HEALTH 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1548042856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANDEEQ HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	1611 PLEASANT ST APT 105
Second Line	:
City	:	LAUDERDALE
State	:	MN
Zip	:	55108-1334
Country	:	US
Telephone Number	:	952-529-5955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 PLEASANT ST APT 105
Second Line	:
City	:	LAUDERDALE
State	:	MN
Zip	:	55108-1334
Country	:	US
Telephone Number	:	952-529-5955
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OFFICER
Name	:	FADIMA AHMED
Credential	:
Telephone Number	:	952-529-5955

Provider Enumeration Date	:	10/20/2023
Last Update Date	:	10/20/2023

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