=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699586206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EQUINOX HEALTH SERVICES L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2025
-----------------------------------------------------
Last Update Date | 01/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1865 OLD HUDSON RD UNIT B2
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55119-4308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-494-7135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1865 OLD HUDSON RD UNIT B2
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55119-4308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-494-7135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ADAN MOHAMUD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-494-7135
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------