Healthcare Provider Details

I. General information

NPI: 1174123376
Provider Name (Legal Business Name): COMO BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 OLD HIGHWAY 8 NW STE 213
NEW BRIGHTON MN
55112-3235
US

IV. Provider business mailing address

441 OLD HIGHWAY 8 NW STE 213
NEW BRIGHTON MN
55112-3235
US

V. Phone/Fax

Practice location:
  • Phone: 612-876-1144
  • Fax: 702-975-5779
Mailing address:
  • Phone: 612-876-1144
  • Fax: 702-975-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LIBIN HASSAN HASHI
Title or Position: MENTAL HEALTH PRACTITIONER
Credential: MHP
Phone: 612-876-1144