MEDICARE: ATHENA BEHAVIORAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003576976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHENA BEHAVIORAL CENTER

Provider Business Mailing Address
First Line	:	2833 13TH AVE S STE 114
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1417
Country	:	US
Telephone Number	:	612-666-3148
Fax Number	:

Provider Business Practice Location Address
First Line	:	2833 13TH AVE S STE 114
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1417
Country	:	US
Telephone Number	:	612-666-3148
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BASHIR SHEIKH
Credential	:
Telephone Number	:	612-666-3148

Provider Enumeration Date	:	12/20/2021
Last Update Date	:	12/20/2021

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