MEDICARE: BRIGHT MINDS ACADEMY LLC

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1316660905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT MINDS ACADEMY LLC

Provider Business Mailing Address
First Line	:	2750 PARK AVE STE 2
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1009
Country	:	US
Telephone Number	:	763-353-1092
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 PARK AVE STE 2
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1009
Country	:	US
Telephone Number	:	763-353-1092
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ABDIFITAH A MOHAMED
Credential	:
Telephone Number	:	763-353-1092

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	04/06/2026

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