Provider Demographics
NPI:1619435401
Name:AURORA BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:AURORA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:JAMAL
Authorized Official - Last Name:SHIREH
Authorized Official - Suffix:
Authorized Official - Credentials:SOCIAL WORKER
Authorized Official - Phone:952-649-0229
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE 225
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2895
Mailing Address - Country:US
Mailing Address - Phone:952-649-0229
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE 225
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2895
Practice Address - Country:US
Practice Address - Phone:952-649-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health