Healthcare Provider Details

I. General information

NPI: 1245195320
Provider Name (Legal Business Name): AVANT HEALTH SD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 11TH AVE
SAN DIEGO CA
92101-6505
US

IV. Provider business mailing address

8300 COMMONWEALTH DR APT 233
EDEN PRAIRIE MN
55344-3369
US

V. Phone/Fax

Practice location:
  • Phone: 612-386-0145
  • Fax:
Mailing address:
  • Phone: 612-386-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: IBRAHIM AHMED
Title or Position: CEO
Credential:
Phone: 612-386-0145