Lilian Watta Boimah – In Home Supportive Care Agency

Key facts

NPI: 1376216655
Entity type: Individual (NPI type 1)
Primary specialty: In Home Supportive Care Agency 253Z00000X
Practice address: 4023 51St Way S
Fargo, ND 58104-6080
Phone: (701) 204-8667
NPI assigned: Jul 31, 2021
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
In Home Supportive Care Agency	253Z00000X			Yes

Addresses

Primary practice location

4023 51St Way S
Fargo, ND 58104-6080

Mailing address

4023 51St Way S
Fargo, ND 58104-6080
Phone (701) 204-8667

Other identifiers

Identifier	Type	State	Issuer
85-1786436	Medicaid	ND

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 31, 2021.

{
    "created_epoch": "1627689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627689600000",
    "number": "1376216655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4023 51ST WAY S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581046080",
            "telephone_number": "701-204-8667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4023 51ST WAY S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581046080",
            "telephone_number": "701-204-8667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOIMAH",
        "first_name": "LILIAN",
        "middle_name": "WATTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-31",
        "last_updated": "2021-07-31",
        "certification_date": "2021-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "85-1786436",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

All providers in Fargo, ND · In Home Supportive Care Agency in North Dakota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.