Extended Health Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

EXTENDED HEALTH SERVICES

Practice address

1928 Portland Ave # S302
Minneapolis, MN 55404-3469

Phone

(612) 517-7558

NPI assigned

Feb 17, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sudi Mohamed

Title

Owner

Phone

(612) 517-7558

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581897600000",
    "number": "1760015879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8200 HUMBOLDT AVE S STE 219",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1928 PORTLAND AVE # S302",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043469",
            "telephone_number": "612-517-7558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-17",
        "last_updated": "2020-02-17",
        "certification_date": "2020-02-17",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "SUDI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-517-7558"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.