MEDICARE: PREMIER HEALTH HOMES 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1568860997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HEALTH HOMES INC

Provider Business Mailing Address
First Line	:	2817 ANTHONY LN S STE 205
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-2490
Country	:	US
Telephone Number	:	651-307-9898
Fax Number	:	651-318-0955

Provider Business Practice Location Address
First Line	:	2817 ANTHONY LN S STE 205
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-2490
Country	:	US
Telephone Number	:	651-307-9898
Fax Number	:	651-318-0955

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	LIIBAAN ALI FARAH
Credential	:
Telephone Number	:	651-307-9898

Provider Enumeration Date	:	12/17/2014
Last Update Date	:	04/03/2025

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