MEDICARE: POLARIS HOME HEALTH 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

General Provider Information

NPI Number	:	1952857005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLARIS HOME HEALTH CARE INC

Provider Business Mailing Address
First Line	:	8609 LYNDALE AVE S STE 213C
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55420-2769
Country	:	US
Telephone Number	:	952-777-4625
Fax Number	:	952-777-4627

Provider Business Practice Location Address
First Line	:	8609 LYNDALE AVE S STE 213C
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55420-2769
Country	:	US
Telephone Number	:	952-777-4625
Fax Number	:	952-777-4627

Authorized Official
Title or Position	:	CEO
Name	:	MR. ABDIRASHID HASSAN-WALI ABDI
Credential	:
Telephone Number	:	952-777-4625

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	12/12/2017

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