Healthcare Provider Details

I. General information

NPI: 1306681036
Provider Name (Legal Business Name): SOOMAAL MEDICAL STAFFING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/29/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 32ND ST S UNIT 10411
FARGO ND
58106-4858
US

IV. Provider business mailing address

1455 32ND ST S UNIT 10411
FARGO ND
58106-4858
US

V. Phone/Fax

Practice location:
  • Phone: 701-739-5464
  • Fax:
Mailing address:
  • Phone: 701-739-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ABDIRIZAK MOHAMED AHMED
Title or Position: CO FOUNDER
Credential: RRT
Phone: 701-739-5464