Provider Demographics
NPI:1689488389
Name:JMI RECUPERATIVE CARE LLC
Entity type:Organization
Organization Name:JMI RECUPERATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:FARDOWSA
Authorized Official - Middle Name:FARAH
Authorized Official - Last Name:OSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:612-245-8475
Mailing Address - Street 1:12310 SINGLETREE LN APT 2344
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7983
Mailing Address - Country:US
Mailing Address - Phone:585-967-1794
Mailing Address - Fax:
Practice Address - Street 1:12310 SINGLETREE LN APT 2344
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7983
Practice Address - Country:US
Practice Address - Phone:585-967-1794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care