Provider Demographics
NPI:1013297027
Name:NGUFOR
Entity Type:Organization
Organization Name:NGUFOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER (ADMINISTRATOR)
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:AZEH
Authorized Official - Last Name:NGUFOR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:651-329-6478
Mailing Address - Street 1:6500 BROOKLYN BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1754
Mailing Address - Country:US
Mailing Address - Phone:651-329-6478
Mailing Address - Fax:763-205-5899
Practice Address - Street 1:6500 BROOKLYN BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1754
Practice Address - Country:US
Practice Address - Phone:651-329-6478
Practice Address - Fax:763-205-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28144251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health