Provider Demographics
NPI:1184335903
Name:TRIPLE A NURSING CARE GROUP LLC
Entity type:Organization
Organization Name:TRIPLE A NURSING CARE GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WUDNEH
Authorized Official - Middle Name:O
Authorized Official - Last Name:GAGA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:507-990-2474
Mailing Address - Street 1:2230 26TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8057
Mailing Address - Country:US
Mailing Address - Phone:507-990-2474
Mailing Address - Fax:507-540-8175
Practice Address - Street 1:2230 26TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8057
Practice Address - Country:US
Practice Address - Phone:507-990-2474
Practice Address - Fax:507-540-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1184335903Medicaid
MN38890Medicaid