MEDICARE: RISE HOME HEALTHCARE 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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1750920989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	8030 MCKINLEY ST NE
Second Line	:
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-2218
Country	:	US
Telephone Number	:	612-207-5920
Fax Number	:

Provider Business Practice Location Address
First Line	:	8030 MCKINLEY ST NE
Second Line	:
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-2218
Country	:	US
Telephone Number	:	612-207-5920
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	NAEEMA SALEH
Credential	:	RB
Telephone Number	:	612-207-5920

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	01/06/2020

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