Provider Demographics
NPI:1689421935
Name:CENTURION HOME HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:CENTURION HOME HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BASHEIR
Authorized Official - Middle Name:W
Authorized Official - Last Name:ELMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-679-0020
Mailing Address - Street 1:1518 E LAKE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1849
Mailing Address - Country:US
Mailing Address - Phone:612-354-2661
Mailing Address - Fax:612-886-1753
Practice Address - Street 1:1518 E LAKE ST STE 210
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1849
Practice Address - Country:US
Practice Address - Phone:612-354-2661
Practice Address - Fax:612-886-1753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care