Provider Demographics
NPI:1093413882
Name:GIRMA A DUFERA AND EDOSHE B GARI
Entity Type:Organization
Organization Name:GIRMA A DUFERA AND EDOSHE B GARI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM CO-ORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GIRMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUFERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-517-8429
Mailing Address - Street 1:14511 LOCKSLIE TRL
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2257
Mailing Address - Country:US
Mailing Address - Phone:612-517-8429
Mailing Address - Fax:
Practice Address - Street 1:14511 LOCKSLIE TRL
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2257
Practice Address - Country:US
Practice Address - Phone:612-517-8429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8523691Medicaid