Provider Demographics
NPI:1417612839
Name:COMMUNITY ONE LLC
Entity Type:Organization
Organization Name:COMMUNITY ONE LLC
Other - Org Name:COMMUNITY ONE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HODAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-319-1906
Mailing Address - Street 1:11972 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1516
Mailing Address - Country:US
Mailing Address - Phone:507-319-1906
Mailing Address - Fax:651-344-4378
Practice Address - Street 1:11972 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1516
Practice Address - Country:US
Practice Address - Phone:507-319-1906
Practice Address - Fax:651-344-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty