Provider Demographics
NPI:1275124083
Name:HERO KID CENTER LLC
Entity Type:Organization
Organization Name:HERO KID CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OSMAN
Authorized Official - Middle Name:MOHAMUD
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-806-5655
Mailing Address - Street 1:8200 HUMBOLDT AVE S
Mailing Address - Street 2:210
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431
Mailing Address - Country:US
Mailing Address - Phone:612-806-5655
Mailing Address - Fax:952-556-9845
Practice Address - Street 1:8200 HUMBOLDT AVE S
Practice Address - Street 2:210
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431
Practice Address - Country:US
Practice Address - Phone:612-806-5655
Practice Address - Fax:952-556-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services