Provider Demographics
NPI:1699407148
Name:FAMILY CARE BEHAVIORAL CENTER
Entity Type:Organization
Organization Name:FAMILY CARE BEHAVIORAL CENTER
Other - Org Name:FAMILY CARE BEHAVIORAL CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMDI
Authorized Official - Middle Name:MOHAMUD
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-636-5139
Mailing Address - Street 1:1406 19TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-4661
Mailing Address - Country:US
Mailing Address - Phone:612-636-5139
Mailing Address - Fax:
Practice Address - Street 1:1406 19TH ST SE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-4661
Practice Address - Country:US
Practice Address - Phone:612-636-5139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency