Healthcare Provider Details

I. General information

NPI: 1861990459
Provider Name (Legal Business Name): BUILDING FAMILY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030 OLD CEDAR AVE S STE 110
BLOOMINGTON MN
55425-1214
US

IV. Provider business mailing address

1605 CLIFF RD E APT 128
BURNSVILLE MN
55337-1332
US

V. Phone/Fax

Practice location:
  • Phone: 952-454-0421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FARDOWSA ALI
Title or Position: CEO
Credential:
Phone: 952-454-0421