NPIMap

Organization Active NPI

Pro-Health Home Care Agency, LLC

  • Home Health Agency
  • Columbia Heights, MN
National Provider Identifier
1174847487
Registry record updated May 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
343901 Issued in MN
Legal business name
PRO-HEALTH HOME CARE AGENCY, LLC
Practice address
4710 Central Ave NE
Columbia Heights, MN 55421-1944
Phone
(763) 746-8155
Fax
(763) 746-8154
NPI assigned
Mar 16, 2010
Organization subpart
Yes
Parent organization
PRO-HEALTH CARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 31, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Abdulwahab M Asamarai, M.D., PH.D.
Title
President/Ceo
Phone
(763) 746-8155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 343901 MN Primary

Addresses

Primary practice location

4710 Central Ave NE
Columbia Heights, MN 55421-1944

Mailing address

4710 Central Ave NE
Columbia Heights, MN 55421-1944
Phone (763) 746-8155

Other names 1

  • Pro-Health PDN Services, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pro-Health Home Care Agency LLC2 organizations share this tax ID, including this one
Part of
Pro-Health Care Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4710 Central Ave NE
Columbia Heights, MN 55421
Phone (763) 746-8155

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464652800000",
    "number": "1174847487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4710 CENTRAL AVE NE",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554211944",
            "telephone_number": "763-746-8155",
            "fax_number": "763-746-8154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4710 CENTRAL AVE NE",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554211944",
            "telephone_number": "763-746-8155",
            "fax_number": "763-746-8154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO-HEALTH HOME CARE AGENCY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRO-HEALTH CARE, INC",
        "enumeration_date": "2010-03-16",
        "last_updated": "2016-05-31",
        "status": "A",
        "authorized_official_last_name": "ASAMARAI",
        "authorized_official_first_name": "ABDULWAHAB",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "763-746-8155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PH.D."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "343901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro-Health PDN Services, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia Heights, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.