MEDICARE: YOUR WAY HOME CARE INC

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	333467	MN

General Provider Information

NPI Number	:	1942373303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR WAY HOME CARE INC

Provider Business Mailing Address
First Line	:	3260 BASS LAKE RD
Second Line	:	SUITE C
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3076
Country	:	US
Telephone Number	:	763-533-3135
Fax Number	:	763-533-3178

Provider Business Practice Location Address
First Line	:	3260 BASS LAKE RD
Second Line	:	SUITE C
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-2612
Country	:	US
Telephone Number	:	763-533-3135
Fax Number	:	763-533-3178

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. JUANITA YVETTE SWAIN
Credential	:
Telephone Number	:	763-533-3135

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	11/04/2011

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