| Community One Llc | |
|
11972 Portland Ave Burnsville MN 55337-1516 | |
| (507) 319-1906 | |
| (651) 344-4378 |
| Full Name | Community One Llc |
|---|---|
| Speciality | Counselor |
| Location | 11972 Portland Ave, Burnsville, Minnesota |
| Authorized Official Name and Position | Hodan H Roble (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5073191906 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community One Llc 11972 Portland Ave Burnsville MN 55337-1516 Ph: (507) 319-1906 | Community One Llc 11972 Portland Ave Burnsville MN 55337-1516 Ph: (507) 319-1906 |
| NPI Number | 1417612839 |
|---|---|
| Provider Enumeration Date | 11/01/2021 |
| Last Update Date | 04/18/2022 |
| Certification Date | 04/18/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417612839 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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