Provider Demographics
NPI:1255754990
Name:NORTH STAR HEALTH SERVICES LLC
Entity type:Organization
Organization Name:NORTH STAR HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SULTAN
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:AMAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-414-0689
Mailing Address - Street 1:8200 HUMBOLDT AVE S
Mailing Address - Street 2:SUITE 3109
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1433
Mailing Address - Country:US
Mailing Address - Phone:612-414-0689
Mailing Address - Fax:
Practice Address - Street 1:8200 HUMBOLDT AVE S
Practice Address - Street 2:SUITE 3109
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1433
Practice Address - Country:US
Practice Address - Phone:612-414-0689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29827251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN29827OtherHEALTH CARE FACILITY ID