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Organization
MIDWEST GROUP HOME
Active
Organization
MIDWEST GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABDIKADIR M HASSAN (OWNER)
(612) 205-4918
Entity
Organization
Contact information
Practice address
4232 5TH ST NE, COLUMBIA HEIGHTS, MN 55421-2860
(612) 205-4918
Mailing address
4232 5TH ST NE, COLUMBIA HEIGHTS, MN 55421-2860
(612) 205-4918
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
395666
MINNESOTA DEPARTMENT OF HEALTH
MN
Enumeration date
10/30/2020
Last updated
11/01/2020
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