Provider Demographics
NPI:1538947817
Name:PURESTART SERVICES LLC
Entity type:Organization
Organization Name:PURESTART SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYASIR
Authorized Official - Middle Name:O FARAH
Authorized Official - Last Name:DAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-991-4529
Mailing Address - Street 1:322 W LAKE ST STE 227
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-5203
Mailing Address - Country:US
Mailing Address - Phone:612-991-4529
Mailing Address - Fax:
Practice Address - Street 1:322 W LAKE ST STE 227
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-5203
Practice Address - Country:US
Practice Address - Phone:612-991-4529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health