Healthcare Provider Details

I. General information

NPI: 1538961644
Provider Name (Legal Business Name): SAKINAH DETOX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 20TH AVE S STE B
MINNEAPOLIS MN
55404-2212
US

IV. Provider business mailing address

900 20TH AVE S STE B
MINNEAPOLIS MN
55404-2212
US

V. Phone/Fax

Practice location:
  • Phone: 612-230-4280
  • Fax:
Mailing address:
  • Phone: 612-230-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SADIK A ALI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 612-205-1113