Sefertt Health Care LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

353744 Issued in MN

Legal business name

SEFERTT HEALTH CARE LLC

Practice address

3621 85TH Ave N
Suite 103
Brooklyn Park, MN 55443-1931

Phone

(651) 278-1144

Fax

(763) 657-7537

NPI assigned

Sep 14, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Mathew Olusakin Amusan, PH.D

Title

Administrator

Phone

(651) 278-1144

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Home health agency certification: CCN 248147

Legal name

SEFERTT HEALTH CARE LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Nov 8, 2017

Last certification

Sep 21, 2017

Ownership / control type

Non-Profit

Organization structure

LLCProprietary

Incorporated

Apr 27, 2011 in MN

Enrollment address

3621 85TH Ave N
Ste 103
Brooklyn Park, MN 55443-1931

Listed as

Sefertt Health Care LLCCCN 248147

Ownership

Non-Profit

Certified

Nov 8, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1315958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451260800000",
    "number": "1801178983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 85TH AVE N",
            "address_2": "SUITE 103",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431931",
            "telephone_number": "651-278-1144",
            "fax_number": "763-657-7537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3621 85TH AVE N",
            "address_2": "SUITE 103",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431931",
            "telephone_number": "651-278-1144",
            "fax_number": "763-657-7537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEFERTT HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-14",
        "last_updated": "2015-12-28",
        "status": "A",
        "authorized_official_last_name": "AMUSAN",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_middle_name": "OLUSAKIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "651-278-1144",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "353744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.