| Abijah's On The Backside | |
|
1100 Canterbury Rd S Shakopee MN 55379-1867 | |
| (715) 379-1370 | |
| Not Available |
| Full Name | Abijah's On The Backside |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1100 Canterbury Rd S, Shakopee, Minnesota |
| Authorized Official Name and Position | Sally Mixon (FOUNDER / CEO) |
| Authorized Official Contact | 7153791370 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Abijah's On The Backside Po Box 583 Shakopee MN 55379-0583 Ph: () - | Abijah's On The Backside 1100 Canterbury Rd S Shakopee MN 55379-1867 Ph: (715) 379-1370 |
| NPI Number | 1245099837 |
|---|---|
| Provider Enumeration Date | 03/15/2024 |
| Last Update Date | 03/15/2024 |
| Certification Date | 03/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245099837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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