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NPI Code Detail

MEDICARE: HENNEPIN AUTISM CENTER INC

MEDICARE: HENNEPIN AUTISM CENTER INC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1275138489
Entity Type Code : Organization
Provider Name (Legal Business Name) : HENNEPIN AUTISM CENTER INC
Provider Business Mailing Address
First Line : 2021 E HENNEPIN AVE STE LL20
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-2738
Country : US
Telephone Number : 612-662-1611
Fax Number :
Provider Business Practice Location Address
First Line : 2021 E HENNEPIN AVE STE LL20
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-2738
Country : US
Telephone Number : 612-662-1611
Fax Number : 651-493-2570
Authorized Official
Title or Position : PRESIDENT
Name : ABDIWAHAB MOHAMED SULEIMAN
Credential :
Telephone Number : 612-622-1611
Provider Enumeration Date : 12/03/2020
Last Update Date : 12/03/2020

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Directions to “HENNEPIN AUTISM CENTER INC ” Practice Location

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