Provider Demographics
NPI:1356013312
Name:LAKES AUTISM CENTER
Entity Type:Organization
Organization Name:LAKES AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAFIA
Authorized Official - Middle Name:FARAH
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-329-4697
Mailing Address - Street 1:1069 GRANDVIEW WAY # 2-317
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3376
Mailing Address - Country:US
Mailing Address - Phone:952-221-6892
Mailing Address - Fax:
Practice Address - Street 1:1069 GRANDVIEW WAY # 2-317
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3376
Practice Address - Country:US
Practice Address - Phone:952-221-6892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)