| NPI | 1821533779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | UBAH ABUBAKER SHIRWA Owner 612-618-5841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MN 1083995-1-HCBS) |
| Additional Taxonomies | 251S00000X (Licence: MN 1083995-1-HCBS) |
| Enumeration Date | 2017-01-02 |
| Last Update Date | 2017-01-02 |