Provisional Health and Rehabilitative Services LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PROVISIONAL HEALTH AND REHABILITATIVE SERVICES LLC

Practice address

4111 Central Ave NE Ste 208B
Columbia Heights, MN 55421-2955

Phone

(763) 205-3258

NPI assigned

Aug 18, 2021

Organization subpart

No

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

Authorized official

Name

Ali Jama

Title

Owner

Phone

(952) 687-9064

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770854400000",
    "number": "1841966116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 CENTRAL AVE NE STE 208B",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554212955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 CENTRAL AVE NE STE 208B",
            "city": "COLUMBIA HEIGHTS",
            "state": "MN",
            "postal_code": "554212955",
            "telephone_number": "763-205-3258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISIONAL HEALTH AND REHABILITATIVE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-18",
        "last_updated": "2026-02-12",
        "certification_date": "2026-02-12",
        "status": "A",
        "authorized_official_last_name": "JAMA",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-687-9064"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Columbia Heights, MN
• Providers in Columbia Heights, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2026; 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.