Healthcare Provider Details

I. General information

NPI: 1548027311
Provider Name (Legal Business Name): KOWKAB HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5724 PERRY AVE N
CRYSTAL MN
55429-2831
US

IV. Provider business mailing address

5724 PERRY AVE N
CRYSTAL MN
55429-2831
US

V. Phone/Fax

Practice location:
  • Phone: 612-245-9169
  • Fax:
Mailing address:
  • Phone: 612-245-9169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HAWA ABDULKADIR GIAMA
Title or Position: OWNER
Credential:
Phone: 612-245-9169