Provider Demographics
NPI:1356806541
Name:ADVANCED HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:ADVANCED HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIFATAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-438-6764
Mailing Address - Street 1:4201 MAIN ST NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2767
Mailing Address - Country:US
Mailing Address - Phone:763-438-6764
Mailing Address - Fax:612-486-8841
Practice Address - Street 1:4201 MAIN ST NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2767
Practice Address - Country:US
Practice Address - Phone:763-438-6764
Practice Address - Fax:612-486-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN389245OtherCOMPREHENSIVE HOME CARELLC