MEDICARE: ADVOCATE SUPPORT SERVICES 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	:	1588485312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVOCATE SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	3623 110TH LN NE
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55449-7702
Country	:	US
Telephone Number	:	619-794-8962
Fax Number	:

Provider Business Practice Location Address
First Line	:	3623 110TH LN NE
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55449-7702
Country	:	US
Telephone Number	:	619-794-8962
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHA ALI ABDULLAHI
Credential	:
Telephone Number	:	619-794-8962

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/24/2024

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