Northeastern Home Group LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

NORTHEASTERN HOME GROUP LLC

Practice address

10255 Greenbrier Rd Apt 122
Minnetonka, MN 55305-3425

Phone

(952) 209-4046

NPI assigned

Apr 1, 2024

Organization subpart

No

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

Authorized official

Name

Fadumo Omar Jama

Title

Director

Phone

(612) 203-2394

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1871344523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 COUNTY ROAD 10 NE APT 234",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554342331",
            "telephone_number": "612-203-2394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10255 GREENBRIER RD APT 122",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553053425",
            "telephone_number": "952-209-4046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN HOME GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-01",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A",
        "authorized_official_last_name": "JAMA",
        "authorized_official_first_name": "FADUMO",
        "authorized_official_middle_name": "OMAR",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "612-203-2394"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Assisted Living Facility (Mental Illness) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; 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.