MEDICARE: SAHAN 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
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	621111	OTHER	MN	AUTISM

General Provider Information

NPI Number	:	1952912164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAHAN INC

Provider Business Mailing Address
First Line	:	2639 NICOLLET AVE # 130
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-1629
Country	:	US
Telephone Number	:	952-994-7876
Fax Number	:

Provider Business Practice Location Address
First Line	:	2639 NICOLLET AVE # 130
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-1629
Country	:	US
Telephone Number	:	952-994-7876
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ABDIRASHID ALI
Credential	:
Telephone Number	:	952-994-7876

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	08/11/2020

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Directions to “SAHAN INC ” Practice Location

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