Provider Demographics
NPI:1639424393
Name:SHABA HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:SHABA HEALTH SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDULLAHI
Authorized Official - Middle Name:SAID
Authorized Official - Last Name:SHABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-867-9699
Mailing Address - Street 1:617 CEDAR AVE S
Mailing Address - Street 2:A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1220
Mailing Address - Country:US
Mailing Address - Phone:612-867-9699
Mailing Address - Fax:612-354-7152
Practice Address - Street 1:617 CEDAR AVE S
Practice Address - Street 2:A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1220
Practice Address - Country:US
Practice Address - Phone:612-867-9699
Practice Address - Fax:612-354-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA977935000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health