Provider Demographics
NPI:1841320066
Name:MGM HOME CARE, INC.
Entity type:Organization
Organization Name:MGM HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:MR
Authorized Official - First Name:IDIRIS
Authorized Official - Middle Name:DIRA
Authorized Official - Last Name:MOHAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:612-338-3636
Mailing Address - Street 1:325 CEDAR AVE S
Mailing Address - Street 2:SUITE #5
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1030
Mailing Address - Country:US
Mailing Address - Phone:612-338-3636
Mailing Address - Fax:612-338-3939
Practice Address - Street 1:325 CEDAR AVE S
Practice Address - Street 2:SUITE #5
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1030
Practice Address - Country:US
Practice Address - Phone:612-338-3636
Practice Address - Fax:612-338-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health