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General NPI Number Information
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NPI Number | 1851042980
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Entity Type | Organization
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Legal Business Name | CHILDRENS BEHAVIORAL CENTER
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 2921 CLIFF RD E
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City | BURNSVILLE
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State | MN
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Zip | 55337-3303
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Country | US
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Telephone | 817-825-7868
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Fax |
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Provider Business Mailing Address
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Address Line | 4809 FOUR SEASONS DR
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City | EAGAN
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State | MN
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Zip | 55122-3325
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Country | US
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Telephone | 817-825-7868
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABDIKARIM BARKHDALE
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Credential |
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Telephone | 817-825-7868
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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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