Healthcare Provider Details

I. General information

NPI: 1205968096
Provider Name (Legal Business Name): ASIAN COMMUNITY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 ARCADE STREET
ST PAUL MN
55106-4540
US

IV. Provider business mailing address

710 ARCADE STREET
ST PAUL MN
55106-4540
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-0111
  • Fax: 651-379-0113
Mailing address:
  • Phone: 651-379-0111
  • Fax: 651-379-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1063125
License Number StateMN

VIII. Authorized Official

Name: MAIKA VANG MOUA
Title or Position: DIRECTOR
Credential:
Phone: 651-379-0111