Provider Demographics
NPI:1750661393
Name:NISAKO SERVICES, LLC
Entity Type:Organization
Organization Name:NISAKO SERVICES, LLC
Other - Org Name:NO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NYEMA
Authorized Official - Last Name:SAYDEE
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:612-703-2901
Mailing Address - Street 1:5201 BRYANT AVE N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-3588
Mailing Address - Country:US
Mailing Address - Phone:612-703-2901
Mailing Address - Fax:763-205-2312
Practice Address - Street 1:5201 BRYANT AVE N
Practice Address - Street 2:SUITE 108
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55430-3588
Practice Address - Country:US
Practice Address - Phone:612-703-2901
Practice Address - Fax:763-205-2312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHE0108404(REV10/00)251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA568602100OtherMINNESOTA DEPT OF HUMAN SERVICES