Organization
SOUTH EAST HOMES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ABAH ABDUL MOHAMED LADC (JOHN PRIN)
(612) 702-7231
Entity
Organization
Contact information
Practice address
2732 BLOOMINGTON AVE, MINNEAPOLIS, MN 55407-1146
(612) 702-7231
Mailing address
2542 17TH AVE S, MINNEAPOLIS, MN 55404-4001
(612) 702-7231
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
1062832-1-CDT
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1058560
DHS LICENSE
MN
Enumeration date
05/26/2011
Last updated
08/17/2012
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