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General NPI Number Information
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NPI Number | 1427841675
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Entity Type | Organization
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Legal Business Name | NATHERS DEVELOPMENT CENTER LLC
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 3887 COON RAPIDS BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-2518
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Country | US
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Telephone | 612-217-3689
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Fax |
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Provider Business Mailing Address
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Address Line | 3887 COON RAPIDS BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-2518
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Country | US
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Telephone | 612-217-3689
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | INTESAR KASIM
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Credential |
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Telephone | 612-217-3689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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