Provider Demographics
NPI:1699262501
Name:B & M VITAL HOMECARE LLC.
Entity type:Organization
Organization Name:B & M VITAL HOMECARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IBADO
Authorized Official - Middle Name:ABDI
Authorized Official - Last Name:HASHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-800-5870
Mailing Address - Street 1:1821 UNIVERSITY AVE., W., STE #S334
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-645-7882
Mailing Address - Fax:651-646-1967
Practice Address - Street 1:1821 UNIVERSITY AVE., W., STE #S334
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-645-7882
Practice Address - Fax:651-646-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health