Provider Demographics
NPI:1801386032
Name:AFRICAN HEALTHCARE CENTER
Entity Type:Organization
Organization Name:AFRICAN HEALTHCARE CENTER
Other - Org Name:AFRICAN HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HIIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:ILMI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:612-208-0910
Mailing Address - Street 1:2647 BLOOMINGTON AVE # NA
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1187
Mailing Address - Country:US
Mailing Address - Phone:161-234-5782
Mailing Address - Fax:
Practice Address - Street 1:2647 BLOOMINGTON AVE # NA
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1187
Practice Address - Country:US
Practice Address - Phone:161-234-5782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health