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General NPI Number Information
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NPI Number | 1023772811
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Entity Type | Organization
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Legal Business Name | CERULEAN MINDS SUPPORT SERVICES
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 1609 SOUTHCROSS DR W
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City | BURNSVILLE
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State | MN
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Zip | 55306-7013
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Country | US
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Telephone | 952-769-4299
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Fax |
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Provider Business Mailing Address
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Address Line | 1609 SOUTHCROSS DR W
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City | BURNSVILLE
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State | MN
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Zip | 55306-7013
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Country | US
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Telephone | 952-769-4299
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ABDIHAKIM IBRAHIM
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Credential |
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Telephone | 763-442-1507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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