Healthcare Provider Details

I. General information

NPI: 1376404558
Provider Name (Legal Business Name): HAFSA BANADE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27691 EUCLID AVE STE B105
EUCLID OH
44132-3550
US

IV. Provider business mailing address

27691 EUCLID AVE STE B105
EUCLID OH
44132-3550
US

V. Phone/Fax

Practice location:
  • Phone: 701-630-9958
  • Fax:
Mailing address:
  • Phone: 701-630-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number202523702396
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: