Provider Demographics
NPI:1932384666
Name:PRO-HEALTH CARE, INC
Entity Type:Organization
Organization Name:PRO-HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDULWAHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:ASAMARAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:763-746-8155
Mailing Address - Street 1:4710 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-1944
Mailing Address - Country:US
Mailing Address - Phone:763-746-8155
Mailing Address - Fax:763-746-8154
Practice Address - Street 1:4710 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-1944
Practice Address - Country:US
Practice Address - Phone:763-746-8155
Practice Address - Fax:763-746-8154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN335929251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN355493000Medicaid
MN825168000Medicaid