Healthcare Provider Details

I. General information

NPI: 1578452892
Provider Name (Legal Business Name): CIRCLE OF SUPPORT CENTER L. L. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 13TH AVE S STE 221
MINNEAPOLIS MN
55407-1417
US

IV. Provider business mailing address

2833 13TH AVE S STE 221
MINNEAPOLIS MN
55407-1417
US

V. Phone/Fax

Practice location:
  • Phone: 612-323-1871
  • Fax:
Mailing address:
  • Phone: 612-323-1871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MUNA HASSAN
Title or Position: OWNER
Credential:
Phone: 612-323-1871