Healthcare Provider Details

I. General information

NPI: 1457978355
Provider Name (Legal Business Name): SIFU HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 COUNTY ROAD B W
ROSEVILLE MN
55113-4213
US

IV. Provider business mailing address

311 EVERGREEN LN
CIRCLE PINES MN
55014-7012
US

V. Phone/Fax

Practice location:
  • Phone: 763-445-1409
  • Fax: 651-286-3300
Mailing address:
  • Phone: 763-445-1409
  • Fax:

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HAYU ABDULLE
Title or Position: DIRECTOR
Credential:
Phone: 763-445-1409