Provider Demographics
NPI:1093043804
Name:METRO HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:METRO HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDI
Authorized Official - Middle Name:GALGALO
Authorized Official - Last Name:GONJOBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-348-7247
Mailing Address - Street 1:1322 BURKE CIR E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3450
Mailing Address - Country:US
Mailing Address - Phone:651-348-7247
Mailing Address - Fax:651-756-1696
Practice Address - Street 1:1322 BURKE CIR E
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-3450
Practice Address - Country:US
Practice Address - Phone:651-348-7247
Practice Address - Fax:651-756-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN379351251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA013422200Medicaid
MNA806655300Medicaid