Provider Demographics
NPI:1972266641
Name:SILVER LAKE HOMES
Entity Type:Organization
Organization Name:SILVER LAKE HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:KASSIM
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:612-701-7232
Mailing Address - Street 1:904 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6830
Mailing Address - Country:US
Mailing Address - Phone:612-701-7232
Mailing Address - Fax:
Practice Address - Street 1:904 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6830
Practice Address - Country:US
Practice Address - Phone:612-701-7232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health