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General NPI Number Information
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NPI Number | 1679894364
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Entity Type | Organization
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Legal Business Name | SOMALI SENIOR CENTER LLC
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 3015 CEDAR AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1805
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Country | US
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Telephone | 612-709-3686
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Fax |
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Provider Business Mailing Address
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Address Line | 3015 CEDAR AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1805
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Country | US
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Telephone | 612-709-3686
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHA HIBAD
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Credential |
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Telephone | 612-709-3686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 10565881
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License Number State | MN
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