Organization
NORTHEASTERN HOME GROUP LLC
Active
Organization
NORTHEASTERN HOME GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FADUMO OMAR JAMA (DIRECTOR)
(612) 203-2394
Entity
Organization
Contact information
Practice address
10255 GREENBRIER RD APT 122, MINNETONKA, MN 55305-3425
(952) 209-4046
Mailing address
716 COUNTY ROAD 10 NE APT 234, BLAINE, MN 55434-2331
(612) 203-2394
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
04/01/2024
Last updated
08/12/2025
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