=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386240026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNNYHEARTS CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2020
-----------------------------------------------------
Last Update Date | 12/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1113 E FRANKLIN AVE STE 111
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55404-2978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-433-6177
-----------------------------------------------------
Fax | 612-924-3333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1113 E FRANKLIN AVE STE 111
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55404-2978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-433-6177
-----------------------------------------------------
Fax | 612-924-3333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. AHMED OSMAN ABDI
-----------------------------------------------------
Credential | CEO
-----------------------------------------------------
Telephone | 612-433-6177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------