| Credent Care Llc | |
|
2719 W Division St Ste 124 Saint Cloud MN 56301-3822 | |
| (612) 987-9775 | |
| Not Available |
| Full Name | Credent Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2719 W Division St Ste 124, Saint Cloud, Minnesota |
| Authorized Official Name and Position | Shirwa Adan (OWNER) |
| Authorized Official Contact | 6129879775 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Credent Care Llc 2719 W Division St Ste 124 Saint Cloud MN 56301-3822 Ph: () - | Credent Care Llc 2719 W Division St Ste 124 Saint Cloud MN 56301-3822 Ph: (612) 987-9775 |
| NPI Number | 1780254920 |
|---|---|
| Provider Enumeration Date | 06/29/2021 |
| Last Update Date | 06/29/2021 |
| Medicare PECOS PAC ID | 0143756700 |
|---|---|
| Medicare Enrollment ID | O20241206000961 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780254920 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Sara R Devos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417388794 PECOS PAC ID: 2365815206 Enrollment ID: I20230227000061 |
| Provider Name | Lance Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013682558 PECOS PAC ID: 1951748466 Enrollment ID: I20240320000768 |
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