Provider Demographics
NPI:1760155881
Name:COMMUNITYWISE SERVICES, INC.
Entity Type:Organization
Organization Name:COMMUNITYWISE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDIGANI
Authorized Official - Middle Name:ABDIRAHMAN
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:763-703-0976
Mailing Address - Street 1:1546 6TH AVE S APT 63
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4044
Mailing Address - Country:US
Mailing Address - Phone:763-703-0976
Mailing Address - Fax:
Practice Address - Street 1:1546 6TH AVE S APT 63
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4044
Practice Address - Country:US
Practice Address - Phone:763-703-0976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1376151837Medicaid