MEDICARE: COMFORT MENTAL CENTER 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1376083139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT MENTAL CENTER LLC

Provider Business Mailing Address
First Line	:	2121 NICOLLET AVE
Second Line	:	SUIT 6
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2566
Country	:	US
Telephone Number	:	612-886-9481
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 NICOLLET AVE
Second Line	:	SUIT 6
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2566
Country	:	US
Telephone Number	:	612-886-9481
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ABDINASIR M AHMED
Credential	:
Telephone Number	:	612-886-9481

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/27/2017

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