Provider Demographics
NPI:1881351534
Name:REDHAWK RESIDENTIAL
Entity type:Organization
Organization Name:REDHAWK RESIDENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIFITAH
Authorized Official - Middle Name:NOR
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS MAN
Authorized Official - Phone:507-990-3783
Mailing Address - Street 1:3565 8 1/2 ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6646
Mailing Address - Country:US
Mailing Address - Phone:507-990-3783
Mailing Address - Fax:
Practice Address - Street 1:3565 8 1/2 ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6646
Practice Address - Country:US
Practice Address - Phone:507-990-3783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty