Healthcare Provider Details

I. General information

NPI: 1972470680
Provider Name (Legal Business Name): MOKAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 MARSHALL AVE
SAINT PAUL MN
55104-6363
US

IV. Provider business mailing address

1509 MARSHALL AVE
SAINT PAUL MN
55104-6363
US

V. Phone/Fax

Practice location:
  • Phone: 612-800-3567
  • Fax:
Mailing address:
  • Phone: 612-800-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. ELMI AHMED MAHAMOUD
Title or Position: MANAGER
Credential:
Phone: 612-800-3567