Provider Demographics
NPI:1508002601
Name:DIVERSE HOME HEALTH CARE
Entity Type:Organization
Organization Name:DIVERSE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAN
Authorized Official - Middle Name:ISSA
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-724-3194
Mailing Address - Street 1:3019 MINNEHAHA AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3099
Mailing Address - Country:US
Mailing Address - Phone:612-724-3194
Mailing Address - Fax:612-729-5224
Practice Address - Street 1:3019 MINNEHAHA AVE STE 10
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-3099
Practice Address - Country:US
Practice Address - Phone:612-724-3194
Practice Address - Fax:612-729-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-20
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2494835-2251E00000X
MN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health