Provider Demographics
NPI:1417534496
Name:ACCESS HOUSE
Entity Type:Organization
Organization Name:ACCESS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUAD
Authorized Official - Middle Name:B
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-528-2869
Mailing Address - Street 1:1883 DEER HILLS TRL
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2284
Mailing Address - Country:US
Mailing Address - Phone:651-528-2869
Mailing Address - Fax:
Practice Address - Street 1:1883 DEER HILLS TRL
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2284
Practice Address - Country:US
Practice Address - Phone:651-528-2869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6515282869Medicaid