Provider Demographics
NPI:1518627736
Name:NORTHSTAR THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:NORTHSTAR THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDULKADIR
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-472-5645
Mailing Address - Street 1:5100 EDINA INDUSTRIAL BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3007
Mailing Address - Country:US
Mailing Address - Phone:952-666-5880
Mailing Address - Fax:952-241-1539
Practice Address - Street 1:5100 EDINA INDUSTRIAL BLVD STE 230
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3007
Practice Address - Country:US
Practice Address - Phone:952-666-5880
Practice Address - Fax:952-241-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health