MEDICARE: CENTRAL CARE SERVICES INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1083281547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL CARE SERVICES INC

Provider Business Mailing Address
First Line	:	3355 HIAWATHA AVE STE 112
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 HIAWATHA AVE STE 112
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2443
Country	:	US
Telephone Number	:	619-817-1931
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NIMO MOHAMUD
Credential	:
Telephone Number	:	619-817-1931

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	06/04/2021

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Directions to “CENTRAL CARE SERVICES INC ” Practice Location

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