MEDICARE: LAVISH DIVINE SERVICES INC.

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1588308639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAVISH DIVINE SERVICES INC.

Provider Business Mailing Address
First Line	:	7204 W 27TH ST STE 213
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-3113
Country	:	US
Telephone Number	:	952-297-2348
Fax Number	:	651-780-7085

Provider Business Practice Location Address
First Line	:	7204 W 27TH ST STE 213
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-3113
Country	:	US
Telephone Number	:	952-297-2348
Fax Number	:	651-780-7085

Authorized Official
Title or Position	:	OWNER
Name	:	FARDOSA HASSAN
Credential	:
Telephone Number	:	952-297-2348

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	04/25/2022

Similar Medicare Providers

1902558877 — LAVISH HEALTH SERVICES , LLC
Practice Location Address:

7204 W 27TH ST STE 213
ST LOUIS PARK, MN
55426-3113

Practice Phone: 952-297-2348
Practice Fax:

1245340025 — DR. ELLIS BASIL MEMOS DDS
Practice Location Address:

5108 HAMPTON AVE
ST LOUIS, MO
63109-3113

Practice Phone: 314-832-4816
Practice Fax: 314-832-4811

1043219215 — DR. LISA A DEBERNARDI DPM
Practice Location Address:

5108 HAMPTON AVE
SAINT LOUIS, MO
63109-3113

Practice Phone: 314-821-3668
Practice Fax: 888-966-0079

1053705392 — SHEARITA SANDOVAL ANP- BC
Practice Location Address:

3113 MAGNOLIA AVE , APT 2E
SAINT LOUIS, MO
63118-1271

Practice Phone: 314-749-6708
Practice Fax:

1003882150 — DR. KAJAL DASGUPTA M.D.
Practice Location Address:

2101 E JEFFERSON ST , KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-2424
Practice Fax:

1881646115 — MS. MELISSA RYAN STRAUSS P.A.
Practice Location Address:

2101 E JEFFERSON ST , KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-2424
Practice Fax:

Directions to “LAVISH DIVINE SERVICES INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.