Healthcare Provider Details

I. General information

NPI: 1417823600
Provider Name (Legal Business Name): NOBLE CHOICE HOME CARE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 OLD HIGHWAY 8 STE 217
ST ANTHONY MN
55418-2492
US

IV. Provider business mailing address

3055 OLD HIGHWAY 8 STE 217
ST ANTHONY MN
55418-2492
US

V. Phone/Fax

Practice location:
  • Phone: 612-380-5876
  • Fax:
Mailing address:
  • Phone: 612-380-5876
  • Fax: 615-636-6136

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: ABDIREZAK A ABDI
Title or Position: GENERAL MANAGER
Credential: NURSE
Phone: 612-380-5876