Healthcare Provider Details

I. General information

NPI: 1760155881
Provider Name (Legal Business Name): COMMUNITYWISE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3339 W SAINT GERMAIN ST STE 250E
SAINT CLOUD MN
56301-7345
US

IV. Provider business mailing address

3339 W SAINT GERMAIN ST STE 250E
SAINT CLOUD MN
56301-7345
US

V. Phone/Fax

Practice location:
  • Phone: 320-281-3037
  • Fax: 320-295-7862
Mailing address:
  • Phone: 320-281-3037
  • Fax: 320-295-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABDIGANI ABDIRAHMAN AHMED
Title or Position: EXECUTIVE DIRECTOR
Credential: LICSW
Phone: 320-281-3037