Provider Demographics
NPI:1699658849
Name:MAA ENTERPRISE LLC
Entity type:Organization
Organization Name:MAA ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:TAI
Authorized Official - Last Name:NYANGAU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:206-396-0842
Mailing Address - Street 1:5050 AMBER VALLEY PKWY S APT 1095050
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5050 AMBER VALLEY PKWY S APT 1095050
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8705
Practice Address - Country:US
Practice Address - Phone:206-396-0842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care