MEDICARE: AFRICAN HEALTHCARE 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	251S00000X	Community/Behavioral Health Agency		MN

General Provider Information

NPI Number	:	1801386032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFRICAN HEALTHCARE CENTER

Provider Business Mailing Address
First Line	:	2647 BLOOMINGTON AVE # NA
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1187
Country	:	US
Telephone Number	:	161-234-5782
Fax Number	:

Provider Business Practice Location Address
First Line	:	2647 BLOOMINGTON AVE # NA
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1187
Country	:	US
Telephone Number	:	161-234-5782
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. HIIS B ILMI
Credential	:	MBA
Telephone Number	:	612-208-0910

Provider Enumeration Date	:	05/14/2018
Last Update Date	:	05/14/2018

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