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General NPI Number Information
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NPI Number | 1073477469
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Entity Type | Organization
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Legal Business Name | AVIDA HOME CARE LLC
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 8594 EXCELSIOR BLVD APT 332
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City | HOPKINS
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State | MN
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Zip | 55343-3461
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Country | US
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Telephone | 701-200-4150
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Fax | 763-260-9928
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Provider Business Mailing Address
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Address Line | 8594 EXCELSIOR BLVD APT 332
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City | HOPKINS
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State | MN
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Zip | 55343-3461
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Country | US
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Telephone | 701-200-4150
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Fax | 763-260-9928
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Authorized Official
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Title or Position | OWNER
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Name | MARYAN ISSACK OSMAN
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Credential | RN
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Telephone | 701-200-4150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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