MEDICARE: WICARE HOME 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1902422520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WICARE HOME CARE LLC

Provider Business Mailing Address
First Line	:	2647 BLOOMINGTON AVE STE C1
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2647 BLOOMINGTON AVE STE C1
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1187
Country	:	US
Telephone Number	:	612-227-9551
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HODAN ABDULKADIR ESSE
Credential	:
Telephone Number	:	612-227-9551

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	06/19/2020

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