MEDICARE: HEALTH CARE & SOCIAL ASSISTANCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1083316053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH CARE & SOCIAL ASSISTANCE LLC

Provider Business Mailing Address
First Line	:	1920 3RD AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2760
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 3RD AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2760
Country	:	US
Telephone Number	:	651-404-9392
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DOUGLAS JOHNSON
Credential	:
Telephone Number	:	651-404-9392

Provider Enumeration Date	:	03/21/2023
Last Update Date	:	03/21/2023

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