Provider Demographics
NPI:1235858721
Name:MIDWEST HOUSING SERVICE LLC
Entity Type:Organization
Organization Name:MIDWEST HOUSING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADUMO
Authorized Official - Middle Name:SERVICE
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-471-4468
Mailing Address - Street 1:308 QUEEN AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-1024
Mailing Address - Country:US
Mailing Address - Phone:612-471-4468
Mailing Address - Fax:
Practice Address - Street 1:308 QUEEN AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-1024
Practice Address - Country:US
Practice Address - Phone:612-471-4468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health