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General NPI Number Information
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NPI Number | 1033887872
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Entity Type | Organization
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Legal Business Name | TUSMO CARE HOMES, LLC
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Dates
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Enumeration Date | 09/04/2021
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Last Update Date | 09/04/2021
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Provider Practice Location Address
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Address Line | 19198 HILLDALE AVE
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City | LAKEVILLE
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State | MN
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Zip | 55044-7955
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Country | US
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Telephone | 763-528-3908
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Fax |
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Provider Business Mailing Address
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Address Line | 19198 HILLDALE AVE
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City | LAKEVILLE
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State | MN
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Zip | 55044-7955
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Country | US
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Telephone | 763-528-3908
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BAHJO A DIRIE
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Credential |
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Telephone | 763-528-3908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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