Provider Demographics
NPI:1073262671
Name:PRIME GROWTH BEHAVIOR SERVICES INC.
Entity Type:Organization
Organization Name:PRIME GROWTH BEHAVIOR SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IDIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GULED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-353-4133
Mailing Address - Street 1:3401 HIAWATHA AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2525
Mailing Address - Country:US
Mailing Address - Phone:612-353-4133
Mailing Address - Fax:612-886-2080
Practice Address - Street 1:3401 HIAWATHA AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2525
Practice Address - Country:US
Practice Address - Phone:612-353-4133
Practice Address - Fax:612-886-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health