Provider Demographics
NPI:1922576081
Name:COMPLEX CARES LLC
Entity Type:Organization
Organization Name:COMPLEX CARES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:DORFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-756-9595
Mailing Address - Street 1:PO BOX 270653
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-0653
Mailing Address - Country:US
Mailing Address - Phone:651-756-9595
Mailing Address - Fax:651-340-8529
Practice Address - Street 1:4700 LEXINGTON AVE N STE C
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5964
Practice Address - Country:US
Practice Address - Phone:651-756-9595
Practice Address - Fax:651-340-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty