Provider Demographics
NPI:1316830359
Name:CICI HEALTH SERVICES LLC
Entity type:Organization
Organization Name:CICI HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOWSIYA
Authorized Official - Middle Name:ABDIHAMID
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-340-4413
Mailing Address - Street 1:1317 E LAKE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-6601
Mailing Address - Country:US
Mailing Address - Phone:763-340-4413
Mailing Address - Fax:
Practice Address - Street 1:1317 E LAKE ST STE 5
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-6601
Practice Address - Country:US
Practice Address - Phone:763-340-4413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center