Provider Demographics
NPI:1033632740
Name:CENTRAL LAKES HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:CENTRAL LAKES HEALTH CARE SERVICES LLC
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAFI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-598-0652
Mailing Address - Street 1:2355 MN-36
Mailing Address - Street 2:410
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:763-377-2418
Mailing Address - Fax:
Practice Address - Street 1:2355 HIGHWAY 36 W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3902
Practice Address - Country:US
Practice Address - Phone:763-377-2418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN382287251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health