Provider Demographics
NPI:1851042980
Name:CHILDRENS BEHAVIORAL CENTER
Entity Type:Organization
Organization Name:CHILDRENS BEHAVIORAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIKARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKHDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-825-7868
Mailing Address - Street 1:4809 FOUR SEASONS DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3325
Mailing Address - Country:US
Mailing Address - Phone:817-825-7868
Mailing Address - Fax:
Practice Address - Street 1:2921 CLIFF RD E
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3303
Practice Address - Country:US
Practice Address - Phone:817-825-7868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDRENS BEHAVIORAL CENTER - EIDBI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health