| Kids Space Llc | |
|
1440 85th Ave Ne Unit D Spring Lake Park MN 55432-1323 | |
| (612) 800-4509 | |
| Not Available |
| Full Name | Kids Space Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1440 85th Ave Ne Unit D, Spring Lake Park, Minnesota |
| Authorized Official Name and Position | Abdusamed M. Hassen (OWNER) |
| Authorized Official Contact | 6128004509 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kids Space Llc 1440 85th Ave Ne Unit D Spring Lake Park MN 55432-1323 Ph: (612) 800-4509 | Kids Space Llc 1440 85th Ave Ne Unit D Spring Lake Park MN 55432-1323 Ph: (612) 800-4509 |
| NPI Number | 1063105724 |
|---|---|
| Provider Enumeration Date | 05/30/2023 |
| Last Update Date | 05/30/2023 |
| Certification Date | 05/30/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063105724 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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