Healthcare Provider Details

I. General information

NPI: 1891740320
Provider Name (Legal Business Name): MAXWELL AFORO ADMINISTRATOR
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 E LAKE ST
MINNEAPOLIS MN
55406-2001
US

IV. Provider business mailing address

3018 EAST LAKE STREET
MINNEAPOLIS MN
55406
US

V. Phone/Fax

Practice location:
  • Phone: 612-721-7776
  • Fax: 612-722-3578
Mailing address:
  • Phone: 612-721-7776
  • Fax: 612-722-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number332211
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberR069057-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: