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General NPI Number Information
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NPI Number | 1811731185
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Entity Type | Organization
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Legal Business Name | COMMUNITY COLLECTIVE SERVICES LLC
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Dates
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Enumeration Date | 06/21/2024
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 1821 UNIVERSITY AVE W # 497
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City | SAINT PAUL
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State | MN
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Zip | 55104-2801
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Country | US
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Telephone | 612-327-3979
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Fax | 612-930-0588
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Provider Business Mailing Address
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Address Line | 1821 UNIVERSITY AVE W # 497
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City | SAINT PAUL
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State | MN
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Zip | 55104-2801
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Country | US
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Telephone | 612-327-3979
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Fax | 612-930-0588
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Authorized Official
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Title or Position | DESIGNATED COORDINATOR/MANAGER
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Name | MS. FARTUN MOHAMED KHALIN
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Credential |
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Telephone | 123-273-9796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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