Provider Demographics
NPI:1093432395
Name:EDINA HEALTH COMPANY
Entity Type:Organization
Organization Name:EDINA HEALTH COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:USAMA
Authorized Official - Middle Name:LIBAN
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-876-7414
Mailing Address - Street 1:2365 LOUISIANA AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55427-3632
Mailing Address - Country:US
Mailing Address - Phone:612-876-7414
Mailing Address - Fax:612-435-1225
Practice Address - Street 1:2365 LOUISIANA AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55427-3632
Practice Address - Country:US
Practice Address - Phone:612-876-7414
Practice Address - Fax:612-435-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8383431OtherMN DEPARTMENT OF REVENUE