MEDICARE: ESSENTIAL CARE CENTERS CORP

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1942986617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL CARE CENTERS CORP

Provider Business Mailing Address
First Line	:	3101 IRVING AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 IRVING AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2516
Country	:	US
Telephone Number	:	952-769-9221
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAM KPAHN
Credential	:
Telephone Number	:	952-769-9221

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	07/21/2023

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