Provider Demographics
NPI:1437669322
Name:ABU HURAIRA ADULT DAY ADULT SERVICES LLC
Entity Type:Organization
Organization Name:ABU HURAIRA ADULT DAY ADULT SERVICES LLC
Other - Org Name:ABU HURAIRA ADULT DAY SERVICE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-453-0105
Mailing Address - Street 1:3055 OLD HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2500
Mailing Address - Country:US
Mailing Address - Phone:763-453-0105
Mailing Address - Fax:
Practice Address - Street 1:3055 OLD HIGHWAY 8
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2500
Practice Address - Country:US
Practice Address - Phone:763-453-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherADULT DAY CARE SERVICES