MEDICARE: FRIENDLY HOME CARE 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	:	1720550684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDLY HOME CARE INC.

Provider Business Mailing Address
First Line	:	3620 CENTRAL AVE NE STE 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-4844
Country	:	US
Telephone Number	:	612-886-2831
Fax Number	:	612-886-3075

Provider Business Practice Location Address
First Line	:	3620 CENTRAL AVE NE STE 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-4844
Country	:	US
Telephone Number	:	612-886-2831
Fax Number	:	612-886-3075

Authorized Official
Title or Position	:	OWNER
Name	:	SHAM HASSAN
Credential	:
Telephone Number	:	612-886-2831

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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