Healthcare Provider Details

I. General information

NPI: 1750799714
Provider Name (Legal Business Name): ROCHESTER ADULT DAY CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 3RD AVE SE APT 122
ROCHESTER MN
55904-6812
US

IV. Provider business mailing address

510 3RD AVE SE APT 122
ROCHESTER MN
55904-6812
US

V. Phone/Fax

Practice location:
  • Phone: 507-990-9445
  • Fax:
Mailing address:
  • Phone: 507-990-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. ABDIAZIZ MUSE MAAHAAY
Title or Position: CEO
Credential:
Phone: 507-990-9445