Provider Demographics
NPI:1013596279
Name:MAHAMED, HAMIDA (LADC)
Entity Type:Individual
Prefix:
First Name:HAMIDA
Middle Name:
Last Name:MAHAMED
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5941 WASHBURN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2848
Mailing Address - Country:US
Mailing Address - Phone:612-709-3686
Mailing Address - Fax:
Practice Address - Street 1:5941 WASHBURN AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-2848
Practice Address - Country:US
Practice Address - Phone:763-587-5513
Practice Address - Fax:612-259-8084
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN108539324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility