Healthcare Provider Details

I. General information

NPI: 1497262224
Provider Name (Legal Business Name): RAJO CARE HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14015 ROCKFORD RD
PLYMOUTH MN
55447
US

IV. Provider business mailing address

14015 ROCKFORD RD
PLYMOUTH MN
55447-5454
US

V. Phone/Fax

Practice location:
  • Phone: 612-859-6065
  • Fax: 952-479-9540
Mailing address:
  • Phone: 612-859-6065
  • Fax: 952-479-9540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number33495
License Number StateMN

VIII. Authorized Official

Name: SAID ABDULKADIR BARRE
Title or Position: PRESIDENT
Credential:
Phone: 612-859-6065