Provider Demographics
NPI:1245824408
Name:LILT HOME CARE LLC
Entity type:Organization
Organization Name:LILT HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAMZA
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:MOHAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-208-8925
Mailing Address - Street 1:8049 STRATFORD CIR S
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3146
Mailing Address - Country:US
Mailing Address - Phone:952-484-2752
Mailing Address - Fax:952-556-9757
Practice Address - Street 1:2400 BLAISDELL AVE STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3394
Practice Address - Country:US
Practice Address - Phone:952-484-2752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2025-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1821456104Medicaid