Healthcare Provider Details

I. General information

NPI: 1124820865
Provider Name (Legal Business Name): RELIABLE RECUPERATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

796 CAPITOL HTS
SAINT PAUL MN
55103-1852
US

IV. Provider business mailing address

796 CAPITOL HTS
SAINT PAUL MN
55103-1852
US

V. Phone/Fax

Practice location:
  • Phone: 763-264-7641
  • Fax:
Mailing address:
  • Phone: 763-264-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AHMED MOHAMED SUGULLE
Title or Position: OWNER
Credential:
Phone: 763-264-7641