Healthcare Provider Details

I. General information

NPI: 1841320066
Provider Name (Legal Business Name): MGM HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CEDAR AVE S SUITE #5
MINNEAPOLIS MN
55454-1030
US

IV. Provider business mailing address

325 CEDAR AVE S SUITE #5
MINNEAPOLIS MN
55454-1030
US

V. Phone/Fax

Practice location:
  • Phone: 612-338-3636
  • Fax: 612-338-3939
Mailing address:
  • Phone: 612-338-3636
  • Fax: 612-338-3939

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: MR. IDIRIS DIRA MOHAMUD
Title or Position: GM
Credential: OWNER
Phone: 612-338-3636