Provider Demographics
NPI:1073258240
Name:RAHA PRIVATE DUTY NURSE LLC
Entity Type:Organization
Organization Name:RAHA PRIVATE DUTY NURSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASRA
Authorized Official - Middle Name:ABDULLAHI
Authorized Official - Last Name:MOHAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:253-205-5780
Mailing Address - Street 1:24452 109TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4932
Mailing Address - Country:US
Mailing Address - Phone:253-205-5780
Mailing Address - Fax:253-322-2317
Practice Address - Street 1:24452 109TH PL SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4932
Practice Address - Country:US
Practice Address - Phone:253-205-5780
Practice Address - Fax:253-322-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care