MEDICARE: CONSCIOUS 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		MN

General Provider Information

NPI Number	:	1962730184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSCIOUS CARE, LLC

Provider Business Mailing Address
First Line	:	5635 100TH LN N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-5700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5635 100TH LN N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-5700
Country	:	US
Telephone Number	:	763-412-9049
Fax Number	:

Authorized Official
Title or Position	:	RN/ADMINISTRATOR
Name	:	ROBERT SAFACK
Credential	:
Telephone Number	:	763-412-9049

Provider Enumeration Date	:	11/29/2009
Last Update Date	:	12/20/2009

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Directions to “CONSCIOUS CARE, LLC ” Practice Location

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