Healthcare Provider Details

I. General information

NPI: 1568082428
Provider Name (Legal Business Name): CLOUD HOME HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WILSON AVE NE STE 204
SAINT CLOUD MN
56304-0418
US

IV. Provider business mailing address

22 WILSON AVE NE STE 204
SAINT CLOUD MN
56304-0418
US

V. Phone/Fax

Practice location:
  • Phone: 317-801-4115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED ABDULLAHI
Title or Position: OWNER
Credential:
Phone: 317-801-4115