Midwest Group Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MIDWEST GROUP HOME

Practice address

4232 5TH St NE
Columbia Heights, MN 55421-2860

Phone

(612) 205-4918

NPI assigned

Oct 30, 2020

Organization subpart

No

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

Authorized official

Name

Abdikadir M Hassan

Title

Owner

Phone

(612) 205-4918

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1604016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604188800000",
    "number": "1871193417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4232 5TH ST NE",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554212860",
            "telephone_number": "612-205-4918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4232 5TH ST NE",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554212860",
            "telephone_number": "612-205-4918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-30",
        "last_updated": "2020-11-01",
        "certification_date": "2020-11-01",
        "status": "A",
        "authorized_official_last_name": "HASSAN",
        "authorized_official_first_name": "ABDIKADIR",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-205-4918"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA DEPARTMENT OF HEALTH",
            "identifier": "395666",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Minnesota Alternatives, LLC
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• Minnesota Spine and Pain Institute, PA
• Miracle Mental Health LLC

• Assisted Living Facility in Columbia Heights, MN
• Providers in Columbia Heights, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.