Provider Demographics
NPI:1174847487
Name:PRO-HEALTH HOME CARE AGENCY, LLC
Entity Type:Organization
Organization Name:PRO-HEALTH HOME CARE AGENCY, LLC
Other - Org Name:PRO-HEALTH PDN SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDULWAHAB
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASAMARAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:763-746-8155
Mailing Address - Street 1:4710 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-1944
Mailing Address - Country:US
Mailing Address - Phone:763-746-8155
Mailing Address - Fax:763-746-8154
Practice Address - Street 1:4710 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-1944
Practice Address - Country:US
Practice Address - Phone:763-746-8155
Practice Address - Fax:763-746-8154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRO-HEALTH CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-16
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343901251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health