Healthcare Provider Details

I. General information

NPI: 1669283693
Provider Name (Legal Business Name): FRIENDLY ADULT DAY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 40TH AVE NE STE 1
COLUMBIA HEIGHTS MN
55421-2903
US

IV. Provider business mailing address

820 40TH AVE NE STE 1
COLUMBIA HEIGHTS MN
55421-2903
US

V. Phone/Fax

Practice location:
  • Phone: 763-957-0321
  • Fax: 763-710-4174
Mailing address:
  • Phone: 763-957-0321
  • Fax: 763-710-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABDU HASSAN
Title or Position: PRESIDENT
Credential:
Phone: 763-957-0321