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NPI Code Detail

MEDICARE: AXIS RESIDENTIAL TREATMENT INC

MEDICARE: AXIS RESIDENTIAL TREATMENT 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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1497413033
Entity Type Code : Organization
Provider Name (Legal Business Name) : AXIS RESIDENTIAL TREATMENT INC
Provider Business Mailing Address
First Line : 219 5TH ST SE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-1108
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 219 5TH ST SE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-1108
Country : US
Telephone Number : 602-903-8781
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SAMIRA NUR
Credential :
Telephone Number : 602-903-8781
Provider Enumeration Date : 12/01/2021
Last Update Date : 12/01/2021

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Directions to “AXIS RESIDENTIAL TREATMENT INC ” Practice Location

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