Healthcare Provider Details

I. General information

NPI: 1154165595
Provider Name (Legal Business Name): ENLIGHT AUTISM CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 UNIVERSITY AVE NE
FRIDLEY MN
55432-1860
US

IV. Provider business mailing address

7920 UNIVERSITY AVE NE
FRIDLEY MN
55432-1860
US

V. Phone/Fax

Practice location:
  • Phone: 763-762-8133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: HALIMO YUSUF ISMAIL
Title or Position: CEO
Credential:
Phone: 612-636-3824