Provider Demographics
NPI:1508637505
Name:MN SPECTRUM SOLUTIONS
Entity Type:Organization
Organization Name:MN SPECTRUM SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:ROBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-735-3198
Mailing Address - Street 1:11346 84TH PL N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-3067
Mailing Address - Country:US
Mailing Address - Phone:612-735-3198
Mailing Address - Fax:
Practice Address - Street 1:11346 84TH PL N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-3067
Practice Address - Country:US
Practice Address - Phone:612-735-3198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care