Provider Demographics
NPI:1275315293
Name:CUSMAN JIIRE LLC
Entity Type:Organization
Organization Name:CUSMAN JIIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FAADIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEIKHMOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-644-4950
Mailing Address - Street 1:6300 YORK AVE S APT 208
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2288
Mailing Address - Country:US
Mailing Address - Phone:612-644-4950
Mailing Address - Fax:
Practice Address - Street 1:6300 YORK AVE S APT 208
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2288
Practice Address - Country:US
Practice Address - Phone:612-644-4950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health