Provider Demographics
NPI:1275321101
Name:ALI, SIRAD MOHAMUD
Entity type:Individual
Prefix:
First Name:SIRAD
Middle Name:MOHAMUD
Last Name:ALI
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 1:1209 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1515
Mailing Address - Country:US
Mailing Address - Phone:402-321-4631
Mailing Address - Fax:
Practice Address - Street 1:1209 N 27TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-1515
Practice Address - Country:US
Practice Address - Phone:402-321-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities