Provider Demographics
NPI:1568266708
Name:MINOUGOU, MOHAMED AIDID
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AIDID
Last Name:MINOUGOU
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 1:19359 W ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-4257
Mailing Address - Country:US
Mailing Address - Phone:531-710-6581
Mailing Address - Fax:
Practice Address - Street 1:19359 W ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-4257
Practice Address - Country:US
Practice Address - Phone:531-710-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities