Healthcare Provider Details

I. General information

NPI: 1538099023
Provider Name (Legal Business Name): MOHAMED ABDI MUSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N 73RD ST
OMAHA NE
68114-1905
US

IV. Provider business mailing address

206 E 39TH ST APT 127
SOUTH SIOUX CITY NE
68776-3682
US

V. Phone/Fax

Practice location:
  • Phone: 402-557-8583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: