Organization
FIRST LIGHT RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOFIA H MOHAMED (OWNER)
(612) 404-7552
Entity
Organization
Contact information
Practice address
2935 AQUILA AVE S, ST LOUIS PARK, MN 55426-2953
(612) 404-7552
Mailing address
2935 AQUILA AVE S, ST LOUIS PARK, MN 55426-2953
(612) 404-7552
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
310400000X
Assisted Living Facility
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
07/17/2019
Last updated
07/17/2019
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