Provider Demographics
NPI:1376787507
Name:ABIDJAN HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ABIDJAN HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:OYEMI
Authorized Official - Middle Name:BRENDA
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-561-3050
Mailing Address - Street 1:1301 72ND AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1122
Mailing Address - Country:US
Mailing Address - Phone:763-561-3050
Mailing Address - Fax:763-561-3050
Practice Address - Street 1:1301 72ND AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1122
Practice Address - Country:US
Practice Address - Phone:763-561-3050
Practice Address - Fax:763-561-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA080980000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health