Healthcare Provider Details

I. General information

NPI: 1992343925
Provider Name (Legal Business Name): CAREXTRA HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 EDINA INDUSTRIAL BLVD STE 114
EDINA MN
55439-2916
US

IV. Provider business mailing address

5275 EDINA INDUSTRIAL BLVD STE 114
EDINA MN
55439-2916
US

V. Phone/Fax

Practice location:
  • Phone: 952-681-7196
  • Fax: 612-464-7237
Mailing address:
  • Phone: 952-681-7196
  • Fax: 612-464-7237

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: IDIL ABDIRAHMAN MOHAMED
Title or Position: OWNER
Credential:
Phone: 612-987-3927