=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386499804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXUS HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2024
-----------------------------------------------------
Last Update Date | 04/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3250 W 66TH ST APT 211
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55435-5511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-898-8280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3250 W 66TH ST APT 211
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55435-5511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-898-8280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ABDIFITAH A MOHAMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 763-898-8280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------