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2445 Park Ave # 300 Minneapolis MN 55404-3714 | |
| (612) 458-1962 | |
| (612) 605-1939 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2445 Park Ave # 300, Minneapolis, Minnesota |
| Authorized Official Name and Position | Rachid Mohamad (CEO) |
| Authorized Official Contact | 6124581962 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2445 Park Ave # 300 Minneapolis MN 55404-3714 Ph: (612) 458-1962 | 2445 Park Ave # 300 Minneapolis MN 55404-3714 Ph: (612) 458-1962 |
| NPI Number | 1962000646 |
|---|---|
| Provider Enumeration Date | 10/14/2020 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/22/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962000646 | NPI | - | NPPES |
| 1962000646 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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