Provider Demographics
NPI:1770966632
Name:ALAAFIA HOMECARE LLC
Entity type:Organization
Organization Name:ALAAFIA HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OLAIDE
Authorized Official - Middle Name:SOLOMON
Authorized Official - Last Name:GABDAMOSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-229-0753
Mailing Address - Street 1:7420 UNITY AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3143
Mailing Address - Country:US
Mailing Address - Phone:612-229-0753
Mailing Address - Fax:
Practice Address - Street 1:7420 UNITY AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3143
Practice Address - Country:US
Practice Address - Phone:612-229-0753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN55665Medicaid