Healthcare Provider Details

I. General information

NPI: 1982534798
Provider Name (Legal Business Name): MIDWEST RESIENTIAL ACHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8344 ALDRICH AVE S
BLOOMINGTON MN
55420-2259
US

IV. Provider business mailing address

8344 ALDRICH AVE S
BLOOMINGTON MN
55420-2259
US

V. Phone/Fax

Practice location:
  • Phone: 612-447-5214
  • Fax:
Mailing address:
  • Phone: 612-447-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MARYAM MOHAMUD
Title or Position: OWNER
Credential:
Phone: 612-447-5214