Provider Demographics
NPI:1962706788
Name:PRO HOME HEALTH CARE
Entity type:Organization
Organization Name:PRO HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIRASHID
Authorized Official - Middle Name:HUSSEIN
Authorized Official - Last Name:BOMBOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-291-7444
Mailing Address - Street 1:355 ORENDORFF WAY NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-5050
Mailing Address - Country:US
Mailing Address - Phone:763-291-7444
Mailing Address - Fax:
Practice Address - Street 1:2910 PILLSBURY AVE S STE 129
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2284
Practice Address - Country:US
Practice Address - Phone:763-291-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1870481251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health