Community Collective Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

COMMUNITY COLLECTIVE SERVICES LLC

Practice address

1821 University Ave W # 497
Saint Paul, MN 55104-2801

Phone

(612) 327-3979

Fax

(612) 930-0588

NPI assigned

Jun 21, 2024

Last updated

Jun 21, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Fartun Mohamed Khalin

Title

Designated Coordinator/Manager

Phone

(123) 273-9796

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1718928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1811731185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 UNIVERSITY AVE W # 497",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551042801",
            "telephone_number": "612-327-3979",
            "fax_number": "612-930-0588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 UNIVERSITY AVE W # 497",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551042801",
            "telephone_number": "612-327-3979",
            "fax_number": "612-930-0588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY COLLECTIVE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-21",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A",
        "authorized_official_last_name": "KHALIN",
        "authorized_official_first_name": "FARTUN",
        "authorized_official_middle_name": "MOHAMED",
        "authorized_official_title_or_position": "DESIGNATED COORDINATOR/MANAGER",
        "authorized_official_telephone_number": "123-273-9796",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Home Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; 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.