| Lavish Divine Services Inc. | |
|
7204 W 27th St Ste 213 St Louis Park MN 55426-3113 | |
| (952) 297-2348 | |
| (651) 780-7085 |
| Full Name | Lavish Divine Services Inc. |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 7204 W 27th St Ste 213, St Louis Park, Minnesota |
| Authorized Official Name and Position | Fardosa Hassan (OWNER) |
| Authorized Official Contact | 9522972348 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lavish Divine Services Inc. 7204 W 27th St Ste 213 St Louis Park MN 55426-3113 Ph: (952) 297-2348 | Lavish Divine Services Inc. 7204 W 27th St Ste 213 St Louis Park MN 55426-3113 Ph: (952) 297-2348 |
| NPI Number | 1588308639 |
|---|---|
| Provider Enumeration Date | 04/25/2022 |
| Last Update Date | 04/25/2022 |
| Certification Date | 04/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588308639 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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