Healthcare Provider Details

I. General information

NPI: 1871463935
Provider Name (Legal Business Name): BRIGHTSIDE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19281 DUNBURY AVE
FARMINGTON MN
55024-8747
US

IV. Provider business mailing address

19281 DUNBURY AVE
FARMINGTON MN
55024-8747
US

V. Phone/Fax

Practice location:
  • Phone: 612-703-2222
  • Fax:
Mailing address:
  • Phone: 612-703-2222
  • Fax:

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: INTISAR MOHAMED WARSAME
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 612-703-2222