Healthcare Provider Details

I. General information

NPI: 1679217954
Provider Name (Legal Business Name): ABYAN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 CENTRAL AVE NE STE 208H
COLUMBIA HEIGHTS MN
55421-2953
US

IV. Provider business mailing address

4111 CENTRAL AVE NE STE 208H
COLUMBIA HEIGHTS MN
55421-2953
US

V. Phone/Fax

Practice location:
  • Phone: 612-223-5124
  • Fax:
Mailing address:
  • Phone: 612-223-5124
  • Fax: 763-777-5349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARMARKE MOHAMUD ALI
Title or Position: MANAGER
Credential:
Phone: 612-275-6282