Provider Demographics
NPI:1821699182
Name:IMMEDIATE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:IMMEDIATE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-868-2265
Mailing Address - Street 1:2817 ANTHONY LN S STE 210
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2488
Mailing Address - Country:US
Mailing Address - Phone:612-259-7362
Mailing Address - Fax:
Practice Address - Street 1:2817 ANTHONY LN S STE 210
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2488
Practice Address - Country:US
Practice Address - Phone:612-259-7362
Practice Address - Fax:612-259-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA724198200Medicaid