Healthcare Provider Details

I. General information

NPI: 1932929296
Provider Name (Legal Business Name): COLLECTIVE HSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 06/08/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 QUEBEC AVE N STE 207B
NEW HOPE MN
55427-1240
US

IV. Provider business mailing address

4124 QUEBEC AVE N STE 207B
NEW HOPE MN
55427-1240
US

V. Phone/Fax

Practice location:
  • Phone: 763-321-5876
  • Fax:
Mailing address:
  • Phone: 763-321-5876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: AHMED OMER
Title or Position: CEO
Credential:
Phone: 404-694-2720