Healthcare Provider Details

I. General information

NPI: 1770370124
Provider Name (Legal Business Name): AVIA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 LILAC DR N STE 160E
GOLDEN VALLEY MN
55422-4535
US

IV. Provider business mailing address

1405 LILAC DR N STE 160E
GOLDEN VALLEY MN
55422-4535
US

V. Phone/Fax

Practice location:
  • Phone: 619-549-9409
  • Fax:
Mailing address:
  • Phone: 619-549-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ABDIKARIM YUSUF
Title or Position: CEO
Credential:
Phone: 619-549-9409