MEDICARE: GRAND ETHNIC MINNESOTA HOME 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1679351860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND ETHNIC MINNESOTA HOME CARE LLC

Provider Business Mailing Address
First Line	:	1973 SLOAN PL STE 230
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-2084
Country	:	US
Telephone Number	:	651-246-1740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1973 SLOAN PL STE 230
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-2084
Country	:	US
Telephone Number	:	651-246-1740
Fax Number	:

Authorized Official
Title or Position	:	OWNER/VICE PRESIDENT
Name	:	YAR SHAY
Credential	:
Telephone Number	:	651-246-1740

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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