MEDICARE: TWIN CITIES RESTORATIVE HEALTH 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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1972363307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN CITIES RESTORATIVE HEALTH LLC

Provider Business Mailing Address
First Line	:	3845 HIAWATHA AVE APT 438
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-4452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 ELLIOT AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-6612
Country	:	US
Telephone Number	:	612-895-0199
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROUMAN OSMAN ILMI
Credential	:
Telephone Number	:	612-895-0199

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	03/21/2024

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