MEDICARE: KA JOOG NONPROFIT ORGANIZATION

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	:	1912412065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KA JOOG NONPROFIT ORGANIZATION

Provider Business Mailing Address
First Line	:	419 CEDAR AVE S # 257
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 WASHINGTON AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55454-1261
Country	:	US
Telephone Number	:	651-795-1589
Fax Number	:	651-795-1589

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MOHAMED ALI FARAH
Credential	:
Telephone Number	:	612-255-3524

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/12/2017

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