Healthcare Provider Details

I. General information

NPI: 1881559557
Provider Name (Legal Business Name): CODAIT HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17622 68TH PL N
MAPLE GROVE MN
55311-3288
US

IV. Provider business mailing address

17622 68TH PL N
MAPLE GROVE MN
55311-3288
US

V. Phone/Fax

Practice location:
  • Phone: 612-859-8058
  • Fax:
Mailing address:
  • Phone: 612-859-8058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: KEHINDE JOSHUA ADEBAYO
Title or Position: MANAGER
Credential:
Phone: 612-859-8058