Provider Demographics
NPI:1033885264
Name:OTTER TAIL HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:OTTER TAIL HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LIBIN
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:HASHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-876-1144
Mailing Address - Street 1:808 BERRY ST APT 150
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1390
Mailing Address - Country:US
Mailing Address - Phone:612-876-1144
Mailing Address - Fax:702-975-5307
Practice Address - Street 1:441 OLD HIGHWAY 8 NW STE 213
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-3235
Practice Address - Country:US
Practice Address - Phone:612-876-1144
Practice Address - Fax:702-975-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty