MEDICARE: LAVISH HEALTH SERVICES , 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	:	1902558877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAVISH HEALTH SERVICES , LLC

Provider Business Mailing Address
First Line	:	7204 W 27TH ST STE 213
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-3113
Country	:	US
Telephone Number	:	952-297-2348
Fax Number	:

Provider Business Practice Location Address
First Line	:	7204 W 27TH ST STE 213
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-3113
Country	:	US
Telephone Number	:	952-297-2348
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	FARDOSA AHMED HASSNA
Credential	:
Telephone Number	:	952-297-2348

Provider Enumeration Date	:	01/21/2022
Last Update Date	:	01/21/2022

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Directions to “LAVISH HEALTH SERVICES , LLC ” Practice Location

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