Healthcare Provider Details

I. General information

NPI: 1821976572
Provider Name (Legal Business Name): ABDIRASHID KASSIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 W SAINT GERMAIN ST STE 750
SAINT CLOUD MN
56301-6389
US

IV. Provider business mailing address

2835 W SAINT GERMAIN ST STE 750
SAINT CLOUD MN
56301-6389
US

V. Phone/Fax

Practice location:
  • Phone: 612-443-8164
  • Fax:
Mailing address:
  • Phone: 612-443-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1126854
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: