Provider Demographics
NPI:1427554799
Name:-
Entity Type:Organization
Organization Name:-
Other - Org Name:GOODHOPE HOMES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FARHIA
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:SIAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-732-2269
Mailing Address - Street 1:2301 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3044
Mailing Address - Country:US
Mailing Address - Phone:763-732-2269
Mailing Address - Fax:
Practice Address - Street 1:2301 16TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3044
Practice Address - Country:US
Practice Address - Phone:763-732-2269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174200000X, 177F00000X, 251J00000X, 310400000X, 332U00000X, 385H00000X
MN33742251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251J00000XAgenciesNursing Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No332U00000XSuppliersHome Delivered Meals
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS386101Medicaid