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General NPI Number Information
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NPI Number | 1801388749
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Entity Type | Organization
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Legal Business Name | NURTURING AUTISM CENTER
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 1712 129TH AVE NE
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City | BLAINE
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State | MN
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Zip | 55449-6264
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Country | US
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Telephone | 612-384-6156
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Fax |
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Provider Business Mailing Address
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Address Line | 1712 129TH AVE NE
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City | BLAINE
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State | MN
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Zip | 55449-6264
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Country | US
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Telephone | 612-384-6156
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ABDI A HUSSEIN
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Credential | DO
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Telephone | 612-384-6156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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