| Dominion Healthcare Services L | |
|
5421 Penn Ave N Brooklyn Center MN 55430-2943 | |
| (612) 258-8794 | |
| Not Available |
| Full Name | Dominion Healthcare Services L |
|---|---|
| Speciality | Clinic/Center |
| Location | 5421 Penn Ave N, Brooklyn Center, Minnesota |
| Authorized Official Name and Position | Yaria Bangura (MANAGER) |
| Authorized Official Contact | 6122588794 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dominion Healthcare Services L 5421 Penn Ave N Brooklyn Center MN 55430-2943 Ph: (612) 258-8794 | Dominion Healthcare Services L 5421 Penn Ave N Brooklyn Center MN 55430-2943 Ph: (612) 258-8794 |
| NPI Number | 1073270427 |
|---|---|
| Provider Enumeration Date | 11/19/2021 |
| Last Update Date | 09/01/2023 |
| Certification Date | 09/01/2023 |
| Medicare PECOS PAC ID | 6406211572 |
|---|---|
| Medicare Enrollment ID | O20230424002460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073270427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Yaria I Bangura |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235680836 PECOS PAC ID: 5698053346 Enrollment ID: I20161031001967 |
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