MEDICARE: ELIZJOSEPH HEALTHCARE 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	163WH0200X	Home Health Registered Nurse
2	251E00000X	Home Health Agency	HFID 31880	MN

General Provider Information

NPI Number	:	1598132086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZJOSEPH HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	2800 FREEWAY BLVD STE 100
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 FREEWAY BLVD STE 100
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	612-501-4029
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	DAMILOLA AGUNBIADE
Credential	:
Telephone Number	:	612-886-9404

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	10/15/2025

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