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NPI Code Detail

MEDICARE: BANNER HEALTH CENTERS LLC

MEDICARE: BANNER HEALTH CENTERS 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1710675277
Entity Type Code : Organization
Provider Name (Legal Business Name) : BANNER HEALTH CENTERS LLC
Provider Business Mailing Address
First Line : 4310 N WOODGATE LN
Second Line :
City : EAGAN
State : MN
Zip : 55122-2277
Country : US
Telephone Number : 651-402-8028
Fax Number :
Provider Business Practice Location Address
First Line : 1200 CENTRE POINTE CURV STE 250
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55120-1353
Country : US
Telephone Number : 651-402-8028
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MOHAMED ABDULLE
Credential :
Telephone Number : 651-402-8028
Provider Enumeration Date : 04/24/2023
Last Update Date : 06/24/2024

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Directions to “BANNER HEALTH CENTERS LLC ” Practice Location

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