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General NPI Number Information
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NPI Number | 1063221000
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Entity Type | Organization
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Legal Business Name | ABA COMMUNITY CARE LLC
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 22 WILSON AVE NE STE 101
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City | SAINT CLOUD
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State | MN
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Zip | 56304-0406
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Country | US
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Telephone | 320-420-3168
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Fax | 320-968-1251
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Provider Business Mailing Address
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Address Line | 22 WILSON AVE NE STE 101
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City | SAINT CLOUD
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State | MN
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Zip | 56304-0406
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Country | US
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Telephone | 320-420-3168
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Fax | 320-968-1251
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Authorized Official
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Title or Position | OWNER
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Name | ABDIRAHMAN MOHAMUD MOHAMED
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Credential |
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Telephone | 320-420-3168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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