Healthcare Provider Details

I. General information

NPI: 1326886128
Provider Name (Legal Business Name): BASRA COMPASSIONATE LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 10TH AVE
NEW GLARUS WI
53574-9402
US

IV. Provider business mailing address

601 10TH AVE
NEW GLARUS WI
53574-9402
US

V. Phone/Fax

Practice location:
  • Phone: 608-556-5281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ABDIQADIR A MOHAMED
Title or Position: SERVICES PROVIDER
Credential:
Phone: 608-556-5281