MEDICARE: RJ'S HOME HEALTH 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1750712345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RJ'S HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	5875 TEAKWOOD LN N
Second Line	:	UNIT B
City	:	PLYMOUTH
State	:	MN
Zip	:	55442-1487
Country	:	US
Telephone Number	:	731-442-9862
Fax Number	:

Provider Business Practice Location Address
First Line	:	5875 TEAKWOOD LN N
Second Line	:	UNIT B
City	:	PLYMOUTH
State	:	MN
Zip	:	55442-1487
Country	:	US
Telephone Number	:	731-442-9862
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RONNIE LORENZO GLYNN JR.
Credential	:
Telephone Number	:	731-442-9862

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	12/06/2013

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