Abundance of Life Adult Family Home, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

ABUNDANCE OF LIFE ADULT FAMILY HOME, LLC

Practice address

2355 Highway 36 W Ste 431
Roseville, MN 55113-3902

Phone

(651) 251-7100

NPI assigned

Jan 17, 2020

Last updated

Jan 17, 2020By 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

Dr. Mahad Ibrahim, PHD

Title

Administrator in Training

Phone

(651) 251-7100

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1579219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579219200000",
    "number": "1730719808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W STE 431",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133902",
            "telephone_number": "651-251-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W STE 431",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133902",
            "telephone_number": "651-251-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABUNDANCE OF LIFE ADULT FAMILY HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-17",
        "last_updated": "2020-01-17",
        "certification_date": "2020-01-17",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "MAHAD",
        "authorized_official_title_or_position": "ADMINISTRATOR IN TRAINING",
        "authorized_official_telephone_number": "651-251-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Roseville, MN
• Providers in Roseville, MN by specialty
• Home Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2020; 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.