MEDICARE: CENTRAL HEALTH SERVICES

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	251B00000X	Case Management Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1891393534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	1828 COLUMBUS AVE APT 202
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1934
Country	:	US
Telephone Number	:	614-805-1982
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 MINNEHAHA AVE STE 2070
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-4600
Country	:	US
Telephone Number	:	614-805-1982
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FAYRUS ABDIRAHMAN DUALE
Credential	:
Telephone Number	:	614-805-1982

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/14/2020

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