Healthcare Provider Details

I. General information

NPI: 1427415066
Provider Name (Legal Business Name): ZAWADI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 EDGEWOOD AVE N
BROOKLYN PARK MN
55445-3212
US

IV. Provider business mailing address

8911 EDGEWOOD AVE N
BROOKLYN PARK MN
55445-3212
US

V. Phone/Fax

Practice location:
  • Phone: 612-310-4728
  • Fax:
Mailing address:
  • Phone: 612-310-4728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. WICLIFFE NYARIGE ONGIGE
Title or Position: OWNER
Credential:
Phone: 612-310-4728