Provider Demographics
NPI:1932434776
Name:PREFERRED CHOICE HOME CARE, LLC
Entity Type:Organization
Organization Name:PREFERRED CHOICE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:ABDIRAHMAN
Authorized Official - Last Name:MUHUMUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-598-9491
Mailing Address - Street 1:15341 FLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-3133
Mailing Address - Country:US
Mailing Address - Phone:612-598-9491
Mailing Address - Fax:612-746-5221
Practice Address - Street 1:15341 FLOWER WAY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-3133
Practice Address - Country:US
Practice Address - Phone:612-598-9491
Practice Address - Fax:612-746-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN346000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNM722947100Medicaid
MN346000OtherCLASS A PROFESSIONAL HOME CARE AGENCY