Provider Demographics
NPI:1366915878
Name:COMMUNITY CARE CLINICS OF MINNESOTA - MHI BUILDING OFFICE
Entity type:Organization
Organization Name:COMMUNITY CARE CLINICS OF MINNESOTA - MHI BUILDING OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LARBI-ODAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-228-0420
Mailing Address - Street 1:1000 S BENTON DR UNIT 421
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1419
Mailing Address - Country:US
Mailing Address - Phone:952-228-0420
Mailing Address - Fax:612-872-8880
Practice Address - Street 1:1000 S BENTON DR UNIT 421
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1419
Practice Address - Country:US
Practice Address - Phone:952-228-0420
Practice Address - Fax:612-872-8880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CARE CLINICS OF MINNESOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-08
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center