Provider Demographics
NPI:1679217954
Name:ABYAN CARE LLC
Entity Type:Organization
Organization Name:ABYAN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARMARKE
Authorized Official - Middle Name:MOHAMUD
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-275-6282
Mailing Address - Street 1:4111 CENTRAL AVE NE STE 208H
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2953
Mailing Address - Country:US
Mailing Address - Phone:612-223-5124
Mailing Address - Fax:763-777-5349
Practice Address - Street 1:4111 CENTRAL AVE NE STE 208H
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2953
Practice Address - Country:US
Practice Address - Phone:612-223-5124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-23
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA221955100OtherHOME CARE SERVICES