Provider Demographics
NPI:1932654662
Name:LUCKY HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:LUCKY HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSAB
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:ADEN
Authorized Official - Suffix:
Authorized Official - Credentials:08/22/2016
Authorized Official - Phone:952-594-0532
Mailing Address - Street 1:2121 NICOLLET AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2575
Mailing Address - Country:US
Mailing Address - Phone:952-594-0532
Mailing Address - Fax:651-683-2757
Practice Address - Street 1:2121 NICOLLET AVE STE 203
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2575
Practice Address - Country:US
Practice Address - Phone:952-594-0532
Practice Address - Fax:651-683-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health