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General NPI Number Information
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NPI Number | 1255754990
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Entity Type | Organization
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Legal Business Name | NORTH STAR HEALTH SERVICES LLC
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Dates
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Enumeration Date | 01/31/2014
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 8200 HUMBOLDT AVE S SUITE 3109
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City | BLOOMINGTON
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State | MN
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Zip | 55431-1433
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Country | US
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Telephone | 612-414-0689
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 HUMBOLDT AVE S SUITE 3109
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City | BLOOMINGTON
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State | MN
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Zip | 55431-1433
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Country | US
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Telephone | 612-414-0689
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SULTAN MOHAMED AMAND
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Credential |
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Telephone | 612-414-0689
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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 | 29827
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License Number State | MN
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