Organization
LIGHTHOUSE RESIDENTIAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABDIRAHMAN MOHAMED DAHIR (OWNER)
(612) 876-0146
Entity
Organization
Contact information
Practice address
7623 W 14TH ST, ST LOUIS PARK, MN 55426-2002
(612) 346-6053
Mailing address
7623 W 14TH ST, ST LOUIS PARK, MN 55426-2002
(612) 346-6053
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
11/25/2020
Last updated
11/25/2020
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