Healthcare Provider Details

I. General information

NPI: 1124979505
Provider Name (Legal Business Name): CREDENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 W DIVISION ST STE 15
SAINT CLOUD MN
56301-3400
US

IV. Provider business mailing address

2719 W DIVISION ST STE 15
SAINT CLOUD MN
56301-3400
US

V. Phone/Fax

Practice location:
  • Phone: 612-987-9775
  • Fax:
Mailing address:
  • Phone: 612-987-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHIRWA ADAN
Title or Position: OWNER
Credential:
Phone: 612-987-9775