Provider Demographics
NPI:1083353908
Name:CAREMMAX
Entity Type:Organization
Organization Name:CAREMMAX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:FARHIYO
Authorized Official - Middle Name:
Authorized Official - Last Name:IDIFLE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:320-224-2234
Mailing Address - Street 1:2615 42ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-5490
Mailing Address - Country:US
Mailing Address - Phone:320-224-2234
Mailing Address - Fax:
Practice Address - Street 1:2615 42ND AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-5490
Practice Address - Country:US
Practice Address - Phone:320-224-2234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty