MEDICARE: CENTRAL LAKES HEALTH CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	382287	MN

General Provider Information

NPI Number	:	1033632740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL LAKES HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2355 MN-36
Second Line	:	410
City	:	ROSEVILLE
State	:	MN
Zip	:	55113
Country	:	US
Telephone Number	:	763-377-2418
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 HIGHWAY 36 W
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-3902
Country	:	US
Telephone Number	:	763-377-2418
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. SHAFI ABDULLE
Credential	:
Telephone Number	:	612-598-0652

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	07/21/2022

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