Healthcare Provider Details

I. General information

NPI: 1649463936
Provider Name (Legal Business Name): BANAADIRI HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 NICOLLET AVE STE 104
MINNEAPOLIS MN
55404-3279
US

IV. Provider business mailing address

2109 NICOLLET AVE STE 104
MINNEAPOLIS MN
55404-3279
US

V. Phone/Fax

Practice location:
  • Phone: 612-870-2738
  • Fax: 612-871-2372
Mailing address:
  • Phone: 612-870-2738
  • Fax: 612-871-2372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateMN

VIII. Authorized Official

Name: MRS. ZAMZAM A GESAADE
Title or Position: DIRECTOR
Credential:
Phone: 612-226-6383