Healthcare Provider Details

I. General information

NPI: 1619695319
Provider Name (Legal Business Name): MIDWEST SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 HENNEPIN AVE STE 104
MINNEAPOLIS MN
55408-3470
US

IV. Provider business mailing address

3249 HENNEPIN AVE STE 104
MINNEAPOLIS MN
55408-3470
US

V. Phone/Fax

Practice location:
  • Phone: 612-444-3747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAID MOHAMED
Title or Position: PRESIDENT
Credential:
Phone: 612-444-3747