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NPI Code Detail

MEDICARE: BRILLANT MINDS SERVICES

MEDICARE: BRILLANT MINDS SERVICES
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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1861258469
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRILLANT MINDS SERVICES
Provider Business Mailing Address
First Line : 1821 UNIVERSITY AVE W STE 120
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-2811
Country : US
Telephone Number : 763-339-8766
Fax Number : 651-389-9401
Provider Business Practice Location Address
First Line : 200 LARPENTEUR AVE E
Second Line :
City : SAINT PAUL
State : MN
Zip : 55117-2339
Country : US
Telephone Number : 763-339-8766
Fax Number : 651-389-9401
Authorized Official
Title or Position : OWNER
Name : MUSTAFA ALI
Credential :
Telephone Number : 651-494-4577
Provider Enumeration Date : 02/22/2024
Last Update Date : 02/22/2024

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Directions to “BRILLANT MINDS SERVICES ” Practice Location

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