Provider Demographics
NPI:1740625367
Name:ACCRA HOME HEALTH, INC
Entity type:Organization
Organization Name:ACCRA HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-935-3515
Mailing Address - Street 1:1932 LONDON RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-2038
Mailing Address - Country:US
Mailing Address - Phone:952-935-3515
Mailing Address - Fax:
Practice Address - Street 1:1932 LONDON RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-2038
Practice Address - Country:US
Practice Address - Phone:952-935-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCRA HOME HEALTH, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-09
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN248002Medicare UPIN