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General NPI Number Information
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NPI Number | 1538961644
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Entity Type | Organization
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Legal Business Name | SAKINAH DETOX LLC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 900 20TH AVE S STE B
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-2212
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Country | US
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Telephone | 612-230-4280
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Fax |
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Provider Business Mailing Address
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Address Line | 900 20TH AVE S STE B
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-2212
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Country | US
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Telephone | 612-230-4280
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SADIK A ALI
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Credential | MD
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Telephone | 612-205-1113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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