MEDICARE: EDINA HEALTH COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8383431	OTHER	MN	MN DEPARTMENT OF REVENUE

General Provider Information

NPI Number	:	1093432395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDINA HEALTH COMPANY

Provider Business Mailing Address
First Line	:	2233 UNIVERSITY AVE W STE 421
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1629
Country	:	US
Telephone Number	:	651-649-4444
Fax Number	:	651-649-4445

Provider Business Practice Location Address
First Line	:	2233 UNIVERSITY AVE W STE 421
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1629
Country	:	US
Telephone Number	:	651-649-4444
Fax Number	:	651-649-4445

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	USAMA LIBAN HASSAN
Credential	:
Telephone Number	:	612-876-7414

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	11/28/2024

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Directions to “EDINA HEALTH COMPANY ” Practice Location

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