Provider Demographics
NPI:1508473216
Name:PILLAR PCA LLC
Entity Type:Organization
Organization Name:PILLAR PCA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMUD
Authorized Official - Middle Name:ABDISALAN
Authorized Official - Last Name:ISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-394-9475
Mailing Address - Street 1:1701 COMO AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2426
Mailing Address - Country:US
Mailing Address - Phone:612-394-9475
Mailing Address - Fax:
Practice Address - Street 1:1701 COMO AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2426
Practice Address - Country:US
Practice Address - Phone:612-394-9475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health