Provider Demographics
NPI:1255825345
Name:SENZILLA HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:SENZILLA HEALTH SERVICES, LLC
Other - Org Name:SENZILLA HEALTH SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMSAM
Authorized Official - Middle Name:OSMAN
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER DEGREE
Authorized Official - Phone:619-471-5686
Mailing Address - Street 1:3055 OLD HIGHWAY 8 STE 101F
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2500
Mailing Address - Country:US
Mailing Address - Phone:612-259-7715
Mailing Address - Fax:612-259-7889
Practice Address - Street 1:3035 OLD HIGHWAY 8
Practice Address - Street 2:SUITE 101F
Practice Address - City:ST. ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418
Practice Address - Country:US
Practice Address - Phone:612-259-7715
Practice Address - Fax:612-259-7889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities