Healthcare Provider Details

I. General information

NPI: 1689488389
Provider Name (Legal Business Name): JMI RECUPERATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12310 SINGLETREE LN APT 2344
EDEN PRAIRIE MN
55344-7983
US

IV. Provider business mailing address

12310 SINGLETREE LN APT 2344
EDEN PRAIRIE MN
55344-7983
US

V. Phone/Fax

Practice location:
  • Phone: 585-967-1794
  • Fax:
Mailing address:
  • Phone: 585-967-1794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FARDOWSA FARAH OSMAN
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 612-245-8475