Provider Demographics
NPI:1124838123
Name:SHEBA
Entity type:Organization
Organization Name:SHEBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SIMELE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADIMASU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-354-8821
Mailing Address - Street 1:2303 DAHL AVE E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-5831
Mailing Address - Country:US
Mailing Address - Phone:651-354-8821
Mailing Address - Fax:
Practice Address - Street 1:2303 DAHL AVE E
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55119-5831
Practice Address - Country:US
Practice Address - Phone:651-354-8821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHEBA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty