Provider Demographics
NPI:1801212592
Name:NOBILITY HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:NOBILITY HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDULREHMAN
Authorized Official - Middle Name:SHECK
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-529-4646
Mailing Address - Street 1:1200 W BROADWAY AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2572
Mailing Address - Country:US
Mailing Address - Phone:612-529-4646
Mailing Address - Fax:612-587-2699
Practice Address - Street 1:1200 W BROADWAY AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2572
Practice Address - Country:US
Practice Address - Phone:612-529-4646
Practice Address - Fax:612-587-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNM750025100OtherMA - MEDICAL ASSISTANCE (MINNESOTA DHS ISSUED)