Lake Nokomis Home Health Care Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

LAKE NOKOMIS HOME HEALTH CARE INC

Practice address

4824 E 53Rd St Apt 413
Minneapolis, MN 55417-5004

Phone

(612) 568-3367

NPI assigned

Oct 5, 2022

Last updated

Oct 5, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abdifatah Gure

Title

Owner

Phone

(612) 568-3367

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664928000000",
    "number": "1659096386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4824 E 53RD ST APT 413",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554175004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4824 E 53RD ST APT 413",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554175004",
            "telephone_number": "612-568-3367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE NOKOMIS HOME HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-05",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A",
        "authorized_official_last_name": "GURE",
        "authorized_official_first_name": "ABDIFATAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-568-3367"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "345",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "A",
            "affiliation": "N",
            "address_1": "4824 E 53rd St Apt 413",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554175004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Home Health Agency in Minneapolis, MN
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.