Organization
LIGHTCARE GROUP HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYAM ABDULKADIR MOHAMED RN (OWNER)
(952) 288-9420
Entity
Organization
Contact information
Practice address
7539 16TH AVE S, RICHFIELD, MN 55423-4620
(612) 866-3014
(612) 866-3014
Mailing address
12310 SINGLETREE LN APT 2143, EDEN PRAIRIE, MN 55344-7967
(952) 288-9420
(612) 866-3014
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
02/18/2020
Last updated
02/18/2020
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