Provider Demographics
NPI:1558659805
Name:CHINESE SOCIAL SERVICE CENTER
Entity Type:Organization
Organization Name:CHINESE SOCIAL SERVICE CENTER
Other - Org Name:CSSC HOMECARE SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YI
Authorized Official - Middle Name:LI
Authorized Official - Last Name:YOU
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:612-529-2602
Mailing Address - Street 1:4111 CENTRAL AVE NE
Mailing Address - Street 2:SUITE 200A, SOUTH BUILDING
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-2953
Mailing Address - Country:US
Mailing Address - Phone:612-529-2602
Mailing Address - Fax:612-465-2733
Practice Address - Street 1:4111 CENTRAL AVE NE
Practice Address - Street 2:SUITE 200A, SOUTH BUILDING
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2953
Practice Address - Country:US
Practice Address - Phone:612-529-2602
Practice Address - Fax:612-465-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN353124251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1031536Medicaid