Healthcare Provider Details

I. General information

NPI: 1518862739
Provider Name (Legal Business Name): ULTIMATE ADULT DAYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 E LAKE ST STE 106
MINNEAPOLIS MN
55407-1771
US

IV. Provider business mailing address

1304 E LAKE ST STE 106
MINNEAPOLIS MN
55407-1771
US

V. Phone/Fax

Practice location:
  • Phone: 651-529-4158
  • Fax: 612-465-6598
Mailing address:
  • Phone: 651-529-4158
  • Fax: 612-465-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MOHAMED SAHAL
Title or Position: OWNER
Credential:
Phone: 651-529-4158