MEDICARE: SEWA-AIFW

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	251T00000X	PACE Provider Organization

General Provider Information

NPI Number	:	1649558131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEWA-AIFW

Provider Business Mailing Address
First Line	:	3702 E LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2156
Country	:	US
Telephone Number	:	763-234-8301
Fax Number	:

Provider Business Practice Location Address
First Line	:	3702 E LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2156
Country	:	US
Telephone Number	:	763-234-8301
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. RAJ MOHINI CHAUDHARY
Credential	:
Telephone Number	:	763-234-8301

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	08/01/2011

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