Healthcare Provider Details

I. General information

NPI: 1669301602
Provider Name (Legal Business Name): PARK PLACE UNITY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 PARK AVE # 100
MINNEAPOLIS MN
55404-3754
US

IV. Provider business mailing address

2304 PARK AVE # 100
MINNEAPOLIS MN
55404-3754
US

V. Phone/Fax

Practice location:
  • Phone: 612-715-4854
  • Fax: 612-715-4854
Mailing address:
  • Phone: 612-715-4854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMINA ABDULLAHI MOHAMED
Title or Position: NURSE MANAGER
Credential: REGISTERED NURSE
Phone: 612-715-4854