MEDICARE: MN HOMECARE BY YUSRA ANGEL HAND LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	251B00000X	Case Management Agency
3	251C00000X	Developmentally Disabled Services Day Training Agency
4	251E00000X	Home Health Agency
5	261QD1600X	Developmental Disabilities Clinic/Center
6	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
7	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
8	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1902425796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MN HOMECARE BY YUSRA ANGEL HAND LLC

Provider Business Mailing Address
First Line	:	4218 GIRARD AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55412-1606
Country	:	US
Telephone Number	:	612-226-8630
Fax Number	:

Provider Business Practice Location Address
First Line	:	4218 GIRARD AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55412-1606
Country	:	US
Telephone Number	:	612-226-8630
Fax Number	:

Authorized Official
Title or Position	:	OWNER/EXCUTIVE DIRECTOR
Name	:	ABDIRAHIM BUSURI
Credential	:
Telephone Number	:	612-226-8630

Provider Enumeration Date	:	04/11/2020
Last Update Date	:	04/11/2020

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