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General NPI Number Information
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NPI Number | 1134786130
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Entity Type | Individual
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Provider Name | MOHAMED SHIDO HASSAN
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Gender | Male
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 05/24/2019
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Provider Practice Location Address
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Address Line | 1312 7TH ST NW STE 203
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City | ROCHESTER
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State | MN
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Zip | 55901-1704
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Country | US
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Telephone | 507-517-9477
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Fax |
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Provider Business Mailing Address
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Address Line | 1990 ASHLAND DR NW UNIT 308
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City | ROCHESTER
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State | MN
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Zip | 55901-5698
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Country | US
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Telephone | 507-517-9477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 1099334
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 1099334
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 1099334
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License Number State | MN
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