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General NPI Number Information
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NPI Number | 1679383939
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Entity Type | Organization
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Legal Business Name | MUSA MIRACLE LIVING INC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 3239 LAKERIDGE DR NW
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City | ROCHESTER
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State | MN
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Zip | 55901-6566
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Country | US
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Telephone | 507-288-1251
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Fax |
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Provider Business Mailing Address
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Address Line | 3239 LAKERIDGE DR NW
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City | ROCHESTER
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State | MN
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Zip | 55901-6566
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Country | US
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Telephone | 507-288-1251
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WARDA MOHAMED SALAH
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Credential |
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Telephone | 507-990-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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