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
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