MEDICARE: SIWA 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1942016456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIWA CENTER LLC

Provider Business Mailing Address
First Line	:	1865 OLD HUDSON RD STE A15
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1865 OLD HUDSON RD STE A15
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4308
Country	:	US
Telephone Number	:	612-701-6361
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	ALI OSMAN
Credential	:
Telephone Number	:	612-701-6361

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	01/06/2026

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