Provider Demographics
NPI:1679383939
Name:MUSA MIRACLE LIVING INC
Entity type:Organization
Organization Name:MUSA MIRACLE LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WARDA
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:SALAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-990-3255
Mailing Address - Street 1:3239 LAKERIDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6566
Mailing Address - Country:US
Mailing Address - Phone:507-288-1251
Mailing Address - Fax:
Practice Address - Street 1:3239 LAKERIDGE DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6566
Practice Address - Country:US
Practice Address - Phone:507-288-1251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility