MEDICARE: SECURE HOUSING ASSISTANCE LLC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1336903236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECURE HOUSING ASSISTANCE LLC

Provider Business Mailing Address
First Line	:	1508 VAN BUREN AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1915
Country	:	US
Telephone Number	:	612-601-6385
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 VAN BUREN AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1915
Country	:	US
Telephone Number	:	612-601-6385
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AYMAN KAMAAL ABDULKADIR
Credential	:
Telephone Number	:	612-601-6385

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/12/2024

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