Healthcare Provider Details

I. General information

NPI: 1659732204
Provider Name (Legal Business Name): DARFUR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 W TRINITY PL
SIOUX FALLS SD
57108-5861
US

IV. Provider business mailing address

3504 W TRINITY PL
SIOX FALLS SD
57108
US

V. Phone/Fax

Practice location:
  • Phone: 623-703-2988
  • Fax:
Mailing address:
  • Phone: 623-703-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberDL047333
License Number StateSD

VIII. Authorized Official

Name: DR. ELTAHIR ABBO
Title or Position: OWNER
Credential:
Phone: 623-703-2988