MEDICARE: MOMENTS PALLIATIVE CARE 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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1942766423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENTS PALLIATIVE CARE LLC

Provider Business Mailing Address
First Line	:	820 LILAC DR N STE 210
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4754
Country	:	US
Telephone Number	:	763-205-3600
Fax Number	:	702-977-1496

Provider Business Practice Location Address
First Line	:	820 LILAC DR N STE 210
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4754
Country	:	US
Telephone Number	:	763-205-3600
Fax Number	:	702-977-1496

Authorized Official
Title or Position	:	OWNER
Name	:	ELIYAHU JAFFA
Credential	:
Telephone Number	:	952-220-6002

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	12/11/2024

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