MEDICARE: BURHAN ADAM DAYNAB ASSISTED LIVING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		MN

General Provider Information

NPI Number	:	1093355216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BURHAN ADAM DAYNAB ASSISTED LIVING

Provider Business Mailing Address
First Line	:	1609 EDGEWOOD AVE S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-2101
Country	:	US
Telephone Number	:	952-564-0682
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 EDGEWOOD AVE S
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-2101
Country	:	US
Telephone Number	:	952-564-0682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	03/19/2020

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