Organization
LAKE NOKOMIS HOME HEALTH CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABDIFATAH GURE (OWNER)
(612) 568-3367
Entity
Organization
Contact information
Practice address
4824 E 53RD ST APT 413, MINNEAPOLIS, MN 55417-5004
(612) 568-3367
Mailing address
4824 E 53RD ST APT 413, MINNEAPOLIS, MN 55417-5004
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
345
—
MN
Enumeration date
10/05/2022
Last updated
10/05/2022
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