Provider Demographics
NPI:1225838279
Name:IBRAHIM, ABDI JAMA
Entity type:Individual
Prefix:
First Name:ABDI
Middle Name:JAMA
Last Name:IBRAHIM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 S 13TH ST APT 106
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-3578
Mailing Address - Country:US
Mailing Address - Phone:402-596-5152
Mailing Address - Fax:
Practice Address - Street 1:1234 S 13TH ST APT 106
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-3578
Practice Address - Country:US
Practice Address - Phone:402-596-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities