Healthcare Provider Details

I. General information

NPI: 1669996369
Provider Name (Legal Business Name): ASPEN ADULT DAYCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 UNIVERSITY AVE W SUITE N196
ST PAUL MN
55104
US

IV. Provider business mailing address

1821 UNIVERSITY AVE W STE N196
SAINT PAUL MN
55104-2870
US

V. Phone/Fax

Practice location:
  • Phone: 651-308-8842
  • Fax:
Mailing address:
  • Phone: 651-308-8842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1085774
License Number StateMN

VIII. Authorized Official

Name: HODAN ABDI HASHI
Title or Position: OWNER
Credential:
Phone: 651-308-8842