| NPI | 1003405853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FADUMO MOHAMED OSMAN Owner 612-402-0013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2021-01-15 |
| Last Update Date | 2021-01-15 |