Healthcare Provider Details

I. General information

NPI: 1154037844
Provider Name (Legal Business Name): HEALING PATH HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 COUNTY ROAD D W STE 213A
NEW BRIGHTON MN
55112-2007
US

IV. Provider business mailing address

1818 E BLUESTONE DR
EAGAN MN
55122-2962
US

V. Phone/Fax

Practice location:
  • Phone: 612-886-5929
  • Fax:
Mailing address:
  • Phone: 612-886-5928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABDIRAHMAN ABDI
Title or Position: AGENCY DIRECTOR/OWNER
Credential:
Phone: 612-886-5928