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General NPI Number Information
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NPI Number | 1285521559
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Entity Type | Organization
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Legal Business Name | ELEGANT LLC
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 260 WENTWORTH AVE E STE 105
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City | WEST SAINT PAUL
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State | MN
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Zip | 55118-3525
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Country | US
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Telephone | 763-607-9377
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Fax |
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Provider Business Mailing Address
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Address Line | 260 WENTWORTH AVE E STE 105
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City | WEST SAINT PAUL
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State | MN
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Zip | 55118-3525
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Country | US
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Telephone | 763-607-9377
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | HASSAN M MOHAMED
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Credential |
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Telephone | 763-607-9377
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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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