Healthcare Provider Details

I. General information

NPI: 1891516530
Provider Name (Legal Business Name): SAFA ABDIRASHID SHEIKHIBRAHIM OWNER/MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 19TH ST NW STE 1
ROCHESTER MN
55901-6792
US

IV. Provider business mailing address

3245 19TH ST NW STE 1
ROCHESTER MN
55901-6792
US

V. Phone/Fax

Practice location:
  • Phone: 507-271-8710
  • Fax:
Mailing address:
  • Phone: 507-271-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: