Provider Demographics
NPI:1922628874
Name:REDESIGN LIFESTYLE CARE LLC
Entity Type:Organization
Organization Name:REDESIGN LIFESTYLE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMDI
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-963-2576
Mailing Address - Street 1:4725 MINNETONKA BLVD APT 301
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2240
Mailing Address - Country:US
Mailing Address - Phone:612-963-2576
Mailing Address - Fax:612-238-8055
Practice Address - Street 1:1527 MORGAN AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3013
Practice Address - Country:US
Practice Address - Phone:612-963-2576
Practice Address - Fax:612-238-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN394113OtherTEMPORARY COMPREHENSIVE HOME CARE LICENSE NUMBER
MN35034OtherHFID #
MN36065OtherHFID #
MN395890OtherHOUSING WITH SERVICES