Healthcare Provider Details

I. General information

NPI: 1952411175
Provider Name (Legal Business Name): FAMILY ACHIEVEMENT CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 WOODDALE DR SUITE A
WOODBURY MN
55125-4441
US

IV. Provider business mailing address

2101 WOODDALE DR SUITE A
WOODBURY MN
55125-4441
US

V. Phone/Fax

Practice location:
  • Phone: 651-738-9888
  • Fax: 651-738-9889
Mailing address:
  • Phone: 651-738-9888
  • Fax: 651-738-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS HOEL
Title or Position: CEO
Credential:
Phone: 651-738-9880