Provider Demographics
NPI:1477170231
Name:MIDWEST GROUP HOMES LLC
Entity Type:Organization
Organization Name:MIDWEST GROUP HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-217-8700
Mailing Address - Street 1:1411 W SAINT GERMAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4179
Mailing Address - Country:US
Mailing Address - Phone:320-217-5302
Mailing Address - Fax:320-217-5302
Practice Address - Street 1:1411 W SAINT GERMAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4179
Practice Address - Country:US
Practice Address - Phone:320-217-5302
Practice Address - Fax:320-217-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN396341OtherHOME CARE LICENSE