Provider Demographics
NPI:1891168811
Name:FARAH, ABDIRIHMAN
Entity Type:Individual
Prefix:
First Name:ABDIRIHMAN
Middle Name:
Last Name:FARAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3552 INDEPENDENCE AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-1760
Mailing Address - Country:US
Mailing Address - Phone:952-217-2319
Mailing Address - Fax:763-544-1276
Practice Address - Street 1:3552 INDEPENDENCE AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-1760
Practice Address - Country:US
Practice Address - Phone:952-217-2319
Practice Address - Fax:763-544-1276
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNW203225846305343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)