Provider Demographics
NPI:1134975485
Name:JAMA, ABDIFARAH HASSAN
Entity type:Individual
Prefix:
First Name:ABDIFARAH
Middle Name:HASSAN
Last Name:JAMA
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 1:14254 CEDAR RD APT 201
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3242
Mailing Address - Country:US
Mailing Address - Phone:614-779-8450
Mailing Address - Fax:
Practice Address - Street 1:14254 CEDAR RD APT 201
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-3242
Practice Address - Country:US
Practice Address - Phone:614-779-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide