Healthcare Provider Details

I. General information

NPI: 1417845470
Provider Name (Legal Business Name): SAFARI HOME SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 W 123RD ST STE 104
SAVAGE MN
55378-5506
US

IV. Provider business mailing address

5505 W 123RD ST STE 104
SAVAGE MN
55378-5506
US

V. Phone/Fax

Practice location:
  • Phone: 952-465-5679
  • Fax:
Mailing address:
  • Phone: 952-465-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ISSA OMAR
Title or Position: OWNER
Credential:
Phone: 952-465-5679