Provider Demographics
NPI:1184288268
Name:MIDWEST COMMUNITY SUPPORT, INC.
Entity type:Organization
Organization Name:MIDWEST COMMUNITY SUPPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUAD
Authorized Official - Middle Name:BASHIR
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-363-9004
Mailing Address - Street 1:7900 EXCELSIOR BLVD STE 2015
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-2600
Mailing Address - Country:US
Mailing Address - Phone:763-363-9004
Mailing Address - Fax:763-592-8023
Practice Address - Street 1:7900 EXCELSIOR BLVD STE 2015
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-2600
Practice Address - Country:US
Practice Address - Phone:612-533-3030
Practice Address - Fax:952-426-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty