Provider Demographics
NPI:1336750769
Name:COMMUNITY CARE PARTNERS
Entity Type:Organization
Organization Name:COMMUNITY CARE PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-532-8027
Mailing Address - Street 1:2817 ANTHONY LN S STE 312
Mailing Address - Street 2:
Mailing Address - City:ST ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2886
Mailing Address - Country:US
Mailing Address - Phone:952-652-3439
Mailing Address - Fax:
Practice Address - Street 1:2817 ANTHONY LN S STE 312
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-2886
Practice Address - Country:US
Practice Address - Phone:952-652-3439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health