Healthcare Provider Details

I. General information

NPI: 1154252054
Provider Name (Legal Business Name): COMMUNITY-CONNECT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 METRO DR STE 260
BLOOMINGTON MN
55425-1548
US

IV. Provider business mailing address

3001 METRO DR STE 260
BLOOMINGTON MN
55425-1548
US

V. Phone/Fax

Practice location:
  • Phone: 952-324-5713
  • Fax: 952-324-5713
Mailing address:
  • Phone: 952-324-5713
  • Fax: 952-324-5713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0104X
TaxonomyChemical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEVIL NUVALA GENJANG
Title or Position: ONNER/CEO
Credential: PHARMD
Phone: 240-486-4147