Provider Demographics
NPI:1184033094
Name:SIIDOW HOME CARE LLC
Entity Type:Organization
Organization Name:SIIDOW HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NALAYE
Authorized Official - Middle Name:MOHAMOUD
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:320-224-6140
Mailing Address - Street 1:810 4TH AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2800
Mailing Address - Country:US
Mailing Address - Phone:320-224-6140
Mailing Address - Fax:
Practice Address - Street 1:810 4TH AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:320-224-6140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDISM905072302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization