Healthcare Provider Details

I. General information

NPI: 1982248324
Provider Name (Legal Business Name): CARE4LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 CIRCLE DR
BURNSVILLE MN
55337-2312
US

IV. Provider business mailing address

1540 CIRCLE DR
BURNSVILLE MN
55337-2312
US

V. Phone/Fax

Practice location:
  • Phone: 952-215-5251
  • Fax: 952-479-9128
Mailing address:
  • Phone: 952-215-5251
  • Fax: 952-479-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: NASRA YUSUF AHMED
Title or Position: RN/OWNER
Credential:
Phone: 952-215-5251