Provider Demographics
NPI:1932663101
Name:ACCESS FAMILY RESOURCE CENTER
Entity Type:Organization
Organization Name:ACCESS FAMILY RESOURCE CENTER
Other - Org Name:ACCESS FAMILY RESOURCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-457-8991
Mailing Address - Street 1:1955 UNIVERSITY AVE W STE 213
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3592
Mailing Address - Country:US
Mailing Address - Phone:952-457-8991
Mailing Address - Fax:
Practice Address - Street 1:1955 UNIVERSITY AVE W STE 213
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3592
Practice Address - Country:US
Practice Address - Phone:952-457-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01Medicaid
MN05Medicaid