MEDICARE: APPLE GROUP HOME INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	343900000X	Non-emergency Medical Transport (VAN)
5	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1831721547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLE GROUP HOME INC.

Provider Business Mailing Address
First Line	:	1404 KENTUCKY AVE S
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55426-2122
Country	:	US
Telephone Number	:	612-242-6245
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 KENTUCKY AVE S
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55426-2122
Country	:	US
Telephone Number	:	612-242-6245
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	NUH A AHMED
Credential	:
Telephone Number	:	612-242-6245

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	02/11/2020

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Directions to “APPLE GROUP HOME INC. ” Practice Location

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