Healthcare Provider Details

I. General information

NPI: 1033888391
Provider Name (Legal Business Name): INOVA CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 DOUGLAS DR N STE 226X
GOLDEN VALLEY MN
55422-4371
US

IV. Provider business mailing address

1710 DOUGLAS DR N STE 226X
GOLDEN VALLEY MN
55422-4371
US

V. Phone/Fax

Practice location:
  • Phone: 612-703-8828
  • Fax:
Mailing address:
  • Phone: 612-703-8828
  • Fax: 952-658-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SOREYA MOHAMUD JAMA
Title or Position: CEO
Credential: LICSW
Phone: 612-703-8828