Provider Demographics
NPI:1356106678
Name:MID HOME CARE LLC
Entity type:Organization
Organization Name:MID HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HIBO
Authorized Official - Middle Name:
Authorized Official - Last Name:SABRIYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-814-1465
Mailing Address - Street 1:3029 22ND AVE S UNIT 503
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-5029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1813 S 6TH ST UNIT 204
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1208
Practice Address - Country:US
Practice Address - Phone:612-814-1465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization