MEDICARE: ROCHESTER HOME CARE

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	3688143-2	MN

General Provider Information

NPI Number	:	1568780278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCHESTER HOME CARE

Provider Business Mailing Address
First Line	:	1504 VALLEYHIGH DR NW
Second Line	:	3
City	:	ROCHESTER
State	:	MN
Zip	:	55901-0738
Country	:	US
Telephone Number	:	612-205-9326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 VALLEYHIGH DR NW
Second Line	:	3
City	:	ROCHESTER
State	:	MN
Zip	:	55901-0738
Country	:	US
Telephone Number	:	612-205-9326
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ABDULLAHI ABDI HUSSEIN
Credential	:
Telephone Number	:	612-205-9326

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	05/06/2010

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