Provider Demographics
NPI:1316609829
Name:CARE SOURCE COMMUNITY SERVICES
Entity type:Organization
Organization Name:CARE SOURCE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ISMAHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:QALIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-310-0448
Mailing Address - Street 1:920 24TH AVE NE UNIT 306
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3482
Mailing Address - Country:US
Mailing Address - Phone:612-310-0448
Mailing Address - Fax:
Practice Address - Street 1:920 24TH AVE NE UNIT 306
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3482
Practice Address - Country:US
Practice Address - Phone:612-310-0448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care