Provider Demographics
NPI:1366208480
Name:MN MEDICAL RESPITE AND RECUPERATIVE
Entity type:Organization
Organization Name:MN MEDICAL RESPITE AND RECUPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SAHRO
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:507-517-9209
Mailing Address - Street 1:808 BERRY ST APT 271
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1377
Mailing Address - Country:US
Mailing Address - Phone:507-517-9209
Mailing Address - Fax:
Practice Address - Street 1:15739 FREMONT WAY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6531
Practice Address - Country:US
Practice Address - Phone:507-517-9209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care