Healthcare Provider Details

I. General information

NPI: 1932097300
Provider Name (Legal Business Name): MR. SYRIDIO HABIMANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LA SALLE DR SW
CEDAR RAPIDS IA
52404
US

IV. Provider business mailing address

420 LA SALLE DR SW
CEDAR RAPIDS IA
52404
US

V. Phone/Fax

Practice location:
  • Phone: 319-693-7811
  • Fax:
Mailing address:
  • Phone: 319-693-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: