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NPI Code Detail

MEDICARE: ABYAN CARE LLC

MEDICARE: ABYAN CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency
2311Z00000XCustodial Care Facility
3251B00000XCase Management Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A221955100OTHERMNHOME CARE SERVICES

General Provider Information

NPI Number : 1679217954
Entity Type Code : Organization
Provider Name (Legal Business Name) : ABYAN CARE LLC
Provider Business Mailing Address
First Line : 4111 CENTRAL AVE NE STE 208H
Second Line :
City : COLUMBIA HEIGHTS
State : MN
Zip : 55421-2953
Country : US
Telephone Number : 612-223-5124
Fax Number : 763-777-5349
Provider Business Practice Location Address
First Line : 4111 CENTRAL AVE NE STE 208H
Second Line :
City : COLUMBIA HEIGHTS
State : MN
Zip : 55421-2953
Country : US
Telephone Number : 612-223-5124
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : SHARMARKE MOHAMUD ALI
Credential :
Telephone Number : 612-275-6282
Provider Enumeration Date : 04/23/2022
Last Update Date : 07/08/2022

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Directions to “ABYAN CARE LLC ” Practice Location

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