Provider Demographics
NPI:1811731185
Name:COMMUNITY COLLECTIVE SERVICES LLC
Entity type:Organization
Organization Name:COMMUNITY COLLECTIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNATED COORDINATOR/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FARTUN
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:KHALIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:123-273-9796
Mailing Address - Street 1:1821 UNIVERSITY AVE W # 497
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2801
Mailing Address - Country:US
Mailing Address - Phone:612-327-3979
Mailing Address - Fax:612-930-0588
Practice Address - Street 1:1821 UNIVERSITY AVE W # 497
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2801
Practice Address - Country:US
Practice Address - Phone:612-327-3979
Practice Address - Fax:612-930-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health