| Icod Llc | |
|
2616 87th Trl N Brooklyn Park MN 55443-3742 | |
| (612) 205-0571 | |
| Not Available |
| Full Name | Icod Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2616 87th Trl N, Brooklyn Park, Minnesota |
| Authorized Official Name and Position | Chuma Dkae (CEO/OWNER) |
| Authorized Official Contact | 6122050571 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icod Llc 2616 87th Trl N Brooklyn Park MN 55443-3742 Ph: (612) 205-0571 | Icod Llc 2616 87th Trl N Brooklyn Park MN 55443-3742 Ph: (612) 205-0571 |
| NPI Number | 1467138529 |
|---|---|
| Provider Enumeration Date | 06/23/2023 |
| Last Update Date | 06/23/2023 |
| Certification Date | 06/23/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467138529 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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