Provider Demographics
NPI:1659732204
Name:DARFUR CARE LLC
Entity Type:Organization
Organization Name:DARFUR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELTAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-703-2988
Mailing Address - Street 1:3504 W TRINITY PL
Mailing Address - Street 2:
Mailing Address - City:SIOX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108
Mailing Address - Country:US
Mailing Address - Phone:623-703-2988
Mailing Address - Fax:
Practice Address - Street 1:3504 W TRINITY PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5861
Practice Address - Country:US
Practice Address - Phone:623-703-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDDL047333305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization