Healthcare Provider Details

I. General information

NPI: 1104296375
Provider Name (Legal Business Name): CANA-CENTER FOR AFRICANS NOW IN AMERICA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 BASS LAKE RD STE 206
CRYSTAL MN
55429-2766
US

IV. Provider business mailing address

6000 BASS LAKE RD STE 206
CRYSTAL MN
55429-2766
US

V. Phone/Fax

Practice location:
  • Phone: 952-356-2953
  • Fax:
Mailing address:
  • Phone: 963-746-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1077869-2-HCBS
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number29973
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1077869-2-HCBS
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number427NAV101
License Number StateMN

VIII. Authorized Official

Name: DR. KATE U ONYENEHO
Title or Position: PRESIDENT/ CEO
Credential: PHD, LISW
Phone: 952-356-2953