Healthcare Provider Details

I. General information

NPI: 1538534037
Provider Name (Legal Business Name): COMMUNITY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 HENSLOW AVE N
OAKDALE MN
55128-5858
US

IV. Provider business mailing address

1070 HENSLOW AVE N
OAKDALE MN
55128-5858
US

V. Phone/Fax

Practice location:
  • Phone: 651-702-2510
  • Fax: 651-735-3307
Mailing address:
  • Phone: 651-702-2510
  • Fax: 651-735-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MARTIN FRU-NDI
Title or Position: OWNER
Credential:
Phone: 651-702-2510