Provider Demographics
NPI:1073838363
Name:NAGOMI INC.
Entity Type:Organization
Organization Name:NAGOMI INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JEONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-968-9134
Mailing Address - Street 1:14424 LOWER GUTHRIE CT
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6744
Mailing Address - Country:US
Mailing Address - Phone:952-431-3037
Mailing Address - Fax:952-431-3037
Practice Address - Street 1:14424 LOWER GUTHRIE CT
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6744
Practice Address - Country:US
Practice Address - Phone:952-431-3037
Practice Address - Fax:952-431-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1048607-1-AFC310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility