Provider Demographics
NPI:1154794089
Name:RESIDENTIAL CARE AT NINE MILE CREEK
Entity type:Organization
Organization Name:RESIDENTIAL CARE AT NINE MILE CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SADIK
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:ABDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-978-2238
Mailing Address - Street 1:10641 JAMES RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-4130
Mailing Address - Country:US
Mailing Address - Phone:952-229-4213
Mailing Address - Fax:
Practice Address - Street 1:10641 JAMES RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-4130
Practice Address - Country:US
Practice Address - Phone:952-229-4213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN374950310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility