Healthcare Provider Details

I. General information

NPI: 1912737057
Provider Name (Legal Business Name): GRAND AMINA SERVICES L. L. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MARIE AVE E STE 202
WEST SAINT PAUL MN
55118-5950
US

IV. Provider business mailing address

60 MARIE AVE E STE 202
WEST SAINT PAUL MN
55118-5950
US

V. Phone/Fax

Practice location:
  • Phone: 651-315-2321
  • Fax: 612-520-5760
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ABSHIR MOHAMED
Title or Position: OWNER
Credential:
Phone: 651-315-2321