Provider Demographics
NPI:1174856017
Name:CENTER FOR AFRICANS NEW TO AMERICA,INC.
Entity Type:Organization
Organization Name:CENTER FOR AFRICANS NEW TO AMERICA,INC.
Other - Org Name:AUTISM SPECTRUM DISORDER PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KATE
Authorized Official - Middle Name:U
Authorized Official - Last Name:ONYENEHO
Authorized Official - Suffix:
Authorized Official - Credentials:ASD
Authorized Official - Phone:612-236-1535
Mailing Address - Street 1:11712 CARTIER AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3227
Mailing Address - Country:US
Mailing Address - Phone:952-356-2953
Mailing Address - Fax:612-276-1535
Practice Address - Street 1:3333 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2615
Practice Address - Country:US
Practice Address - Phone:612-276-1535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR AFRICANS NEW TO AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN365664251C00000X, 252Y00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN625OtherMN GMHA,MA,MINNESOTACARE
MN625Medicaid