Healthcare Provider Details

I. General information

NPI: 1205725843
Provider Name (Legal Business Name): CAREPATH HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 EUSTIS ST #233
LAUDERDALE MN
55108
US

IV. Provider business mailing address

1570 EUSTIS ST #233
LAUDERDALE MN
55108
US

V. Phone/Fax

Practice location:
  • Phone: 612-666-5091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MUSTAPHA MOHAMED ISSA
Title or Position: OWNER
Credential:
Phone: 612-666-5091