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General NPI Number Information
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NPI Number | 1932733284
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Entity Type | Organization
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Legal Business Name | UBBAD LLC
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 09/05/2020
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Provider Practice Location Address
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Address Line | 50 28TH AVE N STE 50
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City | SAINT CLOUD
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State | MN
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Zip | 56303-4241
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Country | US
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Telephone | 612-876-6681
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Fax |
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Provider Business Mailing Address
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Address Line | 4111 CENTRAL AVE NE STE 205
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City | COLUMBIA HEIGHTS
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State | MN
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Zip | 55421-2956
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Country | US
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Telephone | 612-876-6681
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | HASSAN HASSAN
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Credential |
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Telephone | 612-876-6681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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