Healthcare Provider Details

I. General information

NPI: 1598581688
Provider Name (Legal Business Name): MN CARE ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2024
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 PARK AVE RM LL4
MINNEAPOLIS MN
55407-1006
US

IV. Provider business mailing address

2649 PARK AVE RM LL4
MINNEAPOLIS MN
55407-1006
US

V. Phone/Fax

Practice location:
  • Phone: 612-850-2016
  • Fax:
Mailing address:
  • Phone: 612-850-2016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUDI ABDULKADIR AHMED
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 612-850-2016