Provider Demographics
NPI:1275138489
Name:HENNEPIN AUTISM CENTER INC
Entity Type:Organization
Organization Name:HENNEPIN AUTISM CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDIWAHAB
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:SULEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-622-1611
Mailing Address - Street 1:2021 E HENNEPIN AVE STE LL20
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2738
Mailing Address - Country:US
Mailing Address - Phone:612-662-1611
Mailing Address - Fax:
Practice Address - Street 1:2021 E HENNEPIN AVE STE LL20
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2738
Practice Address - Country:US
Practice Address - Phone:612-662-1611
Practice Address - Fax:651-493-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)