MEDICARE: MSAADA 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730822255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSAADA LLC

Provider Business Mailing Address
First Line	:	5919 ABBOTT AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-2626
Country	:	US
Telephone Number	:	763-501-2326
Fax Number	:

Provider Business Practice Location Address
First Line	:	5919 ABBOTT AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-2626
Country	:	US
Telephone Number	:	763-501-2326
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ADRIANNE JANNIBAH GOULD
Credential	:
Telephone Number	:	763-501-2326

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	04/14/2022

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Directions to “MSAADA LLC ” Practice Location

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