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General NPI Number Information
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NPI Number | 1942948252
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Entity Type | Organization
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Legal Business Name | SUCCESS FAMILY CENTER
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 2040 VIKING DR NW
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City | ROCHESTER
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State | MN
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Zip | 55901-3077
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Country | US
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Telephone | 507-491-3765
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Fax |
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Provider Business Mailing Address
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Address Line | 2312 ASHLAND DR NW
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City | ROCHESTER
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State | MN
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Zip | 55901-5669
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Country | US
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Telephone | 507-491-3765
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DAUD A HASSAN
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Credential |
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Telephone | 507-491-3765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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