Provider Demographics
NPI:1639612765
Name:COSMO HOME HEALTHCARE SERVICES, L.L.C.
Entity Type:Organization
Organization Name:COSMO HOME HEALTHCARE SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULKADIR
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:SHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-735-5598
Mailing Address - Street 1:2219 OAKLAND AVE S
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3749
Mailing Address - Country:US
Mailing Address - Phone:612-314-2045
Mailing Address - Fax:612-314-8022
Practice Address - Street 1:2219 OAKLAND AVE S
Practice Address - Street 2:SUITE 104
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-314-2045
Practice Address - Fax:612-314-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN379558251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health