1194854026 NPI number — RAKHMA, INC.

Table of content: (NPI 1194854026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194854026 NPI number — RAKHMA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAKHMA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194854026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4953 ALDRICH AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55419-5352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-824-2345
Provider Business Mailing Address Fax Number:
612-824-3165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4953 ALDRICH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55419-5352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-824-2345
Provider Business Practice Location Address Fax Number:
612-824-3165
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JANELLE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
612-824-2345

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  333403 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4990022 . This is a "ASSITED LIVING PLUS BILLI" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: AL0017 . This is a "UCARE JOY HOME ID NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: AL0030 . This is a "UCARE GRACE HOUSE ID NUM." identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: AL0018 . This is a "UCARE PEACE HOME ID NUMBE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 14602 . This is a "HEALTH PARTNERS AL PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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