Provider Demographics
NPI:1902558877
Name:LAVISH HEALTH SERVICES , LLC
Entity Type:Organization
Organization Name:LAVISH HEALTH SERVICES , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FARDOSA
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:HASSNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-297-2348
Mailing Address - Street 1:7204 W 27TH ST STE 213
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3113
Mailing Address - Country:US
Mailing Address - Phone:952-297-2348
Mailing Address - Fax:
Practice Address - Street 1:7204 W 27TH ST STE 213
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3113
Practice Address - Country:US
Practice Address - Phone:952-297-2348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health