MEDICARE: COMMUNITY OUTREACH 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1891384913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY OUTREACH SERVICES LLC

Provider Business Mailing Address
First Line	:	4921 ALDRICH AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-3532
Country	:	US
Telephone Number	:	763-501-0053
Fax Number	:	612-259-8070

Provider Business Practice Location Address
First Line	:	4921 ALDRICH AVE N
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-3532
Country	:	US
Telephone Number	:	763-501-0053
Fax Number	:	612-259-8070

Authorized Official
Title or Position	:	OWNER
Name	:	JENNY ANN HOLLOWAY
Credential	:
Telephone Number	:	763-501-0053

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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Directions to “COMMUNITY OUTREACH SERVICES LLC ” Practice Location

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