Provider Demographics
NPI:1043005366
Name:DISCOVERY PLACE AUTISM CENTER
Entity type:Organization
Organization Name:DISCOVERY PLACE AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IDIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-816-5623
Mailing Address - Street 1:1701 AMERICAN BLVD E STE 7
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1415
Mailing Address - Country:US
Mailing Address - Phone:612-816-5623
Mailing Address - Fax:
Practice Address - Street 1:1701 AMERICAN BLVD E STE 7
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1415
Practice Address - Country:US
Practice Address - Phone:612-816-5623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251S00000XAgenciesCommunity/Behavioral Health