Provider Demographics
NPI:1649463936
Name:BANAADIRI HOME HEALTHCARE
Entity type:Organization
Organization Name:BANAADIRI HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZAMZAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:GESAADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-226-6383
Mailing Address - Street 1:2109 NICOLLET AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3279
Mailing Address - Country:US
Mailing Address - Phone:612-870-2738
Mailing Address - Fax:612-871-2372
Practice Address - Street 1:2109 NICOLLET AVE STE 104
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3279
Practice Address - Country:US
Practice Address - Phone:612-870-2738
Practice Address - Fax:612-871-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization