Provider Demographics
NPI:1750833034
Name:MINNESOTA PCA HOME HEALTHY CARE LLC
Entity Type:Organization
Organization Name:MINNESOTA PCA HOME HEALTHY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FADUMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-821-2364
Mailing Address - Street 1:310 E 38TH ST STE 126
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1387
Mailing Address - Country:US
Mailing Address - Phone:612-821-2364
Mailing Address - Fax:
Practice Address - Street 1:310 E 38TH ST STE 126
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1387
Practice Address - Country:US
Practice Address - Phone:612-821-2364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA632198200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health