Provider Demographics
NPI:1275849044
Name:HIDDO HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:HIDDO HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMUD
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:NUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-319-7168
Mailing Address - Street 1:1619 EASTWOOD ROAD SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904
Mailing Address - Country:US
Mailing Address - Phone:507-319-7168
Mailing Address - Fax:507-206-6154
Practice Address - Street 1:1619 EASTWOOD RD SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-5168
Practice Address - Country:US
Practice Address - Phone:507-319-7168
Practice Address - Fax:507-206-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNM817281100251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNM817281100Medicaid