Provider Demographics
NPI:1205156080
Name:KAAH ADULT DAY SERVICES
Entity type:Organization
Organization Name:KAAH ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANEGER
Authorized Official - Prefix:
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HODLEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-824-1471
Mailing Address - Street 1:624 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1549
Mailing Address - Country:US
Mailing Address - Phone:612-824-1471
Mailing Address - Fax:
Practice Address - Street 1:624 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1549
Practice Address - Country:US
Practice Address - Phone:612-824-1471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1055318-1-ADC251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services