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General NPI Number Information
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NPI Number | 1487274908
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Entity Type | Organization
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Legal Business Name | EPIC THERAPY
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 2430 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55114-1706
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Country | US
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Telephone | 651-200-4159
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Fax |
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Provider Business Mailing Address
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Address Line | 2430 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55114-1706
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Country | US
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Telephone | 651-200-4159
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | YUSUF ALI
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Credential |
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Telephone | 651-200-4159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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