Healthcare Provider Details

I. General information

NPI: 1316744196
Provider Name (Legal Business Name): COMMUNITY-CONNECT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 METRO DR STE 260
BLOOMINGTON MN
55425-4506
US

IV. Provider business mailing address

3001 METRO DR STE 260
BLOOMINGTON MN
55425-4506
US

V. Phone/Fax

Practice location:
  • Phone: 952-324-5713
  • Fax: 952-378-2860
Mailing address:
  • Phone: 952-324-5713
  • Fax: 952-378-2860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

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