MEDICARE: UNITY CENTER

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	:	1770308900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITY CENTER

Provider Business Mailing Address
First Line	:	2796 NOEL DR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-1238
Country	:	US
Telephone Number	:	651-442-8241
Fax Number	:

Provider Business Practice Location Address
First Line	:	3055 OLD HIGHWAY 8 STE 215
Second Line	:
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-2492
Country	:	US
Telephone Number	:	651-442-8241
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ABDULAHI ISMAIL MOHAMED
Credential	:
Telephone Number	:	651-442-8241

Provider Enumeration Date	:	11/21/2024
Last Update Date	:	11/21/2024

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