MEDICARE: MINNEAPOLIS 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1700243854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNEAPOLIS HOME CARE LLC

Provider Business Mailing Address
First Line	:	2121 NICOLLET AVE #4
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2567
Country	:	US
Telephone Number	:	952-393-4262
Fax Number	:	612-256-8408

Provider Business Practice Location Address
First Line	:	2121 NICOLLET AVE STE 204
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2575
Country	:	US
Telephone Number	:	952-393-4262
Fax Number	:	612-256-8408

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MR. SAADIQ FARAH HASSAN
Credential	:
Telephone Number	:	952-393-4262

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	01/14/2020

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