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NPI Code Detail

MEDICARE: NICOLLET SENIOR CENTER INC

MEDICARE: NICOLLET SENIOR CENTER 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
1251C00000XDevelopmentally Disabled Services Day Training Agency1076746MN

General Provider Information

NPI Number : 1346610599
Entity Type Code : Organization
Provider Name (Legal Business Name) : NICOLLET SENIOR CENTER INC
Provider Business Mailing Address
First Line : 2614 NICOLLET AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-1628
Country : US
Telephone Number : 612-532-4198
Fax Number :
Provider Business Practice Location Address
First Line : 2614 NICOLLET AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-1628
Country : US
Telephone Number : 612-532-4198
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : SHAMSO AHMED HASSAN
Credential :
Telephone Number : 612-532-4198
Provider Enumeration Date : 09/30/2015
Last Update Date : 09/30/2015

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Directions to “NICOLLET SENIOR CENTER INC ” Practice Location

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