Organization
PROVISIONAL HEALTH AND REHABILITATIVE SERVICES LLC
Active
Organization
PROVISIONAL HEALTH AND REHABILITATIVE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALI JAMA (OWNER)
(952) 687-9064
Entity
Organization
Contact information
Practice address
4111 CENTRAL AVE NE STE 208B, COLUMBIA HEIGHTS, MN 55421-2955
(763) 205-3258
Mailing address
4111 CENTRAL AVE NE STE 208B, COLUMBIA HEIGHTS, MN 55421-2955
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
08/18/2021
Last updated
02/12/2026
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up