Healthcare Provider Details

I. General information

NPI: 1578054938
Provider Name (Legal Business Name): PRUDENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3603 CENTERVILLE RD
VADNAIS HEIGHTS MN
55127-7122
US

IV. Provider business mailing address

3603 CENTERVILLE RD
VADNAIS HEIGHTS MN
55127-7122
US

V. Phone/Fax

Practice location:
  • Phone: 612-889-1987
  • Fax:
Mailing address:
  • Phone: 612-889-1987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number33866
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number33866
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number33866
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number33866
License Number StateMN

VIII. Authorized Official

Name: YASIN FARAH MOHAMED
Title or Position: OWNER
Credential:
Phone: 612-889-1987