Provider Demographics
NPI:1184443558
Name:AUTISM BEHAVIORAL CENTER LLC
Entity type:Organization
Organization Name:AUTISM BEHAVIORAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDIRIZAK
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-462-8857
Mailing Address - Street 1:1710 DOUGLAS DR N STE 107
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4397
Mailing Address - Country:US
Mailing Address - Phone:612-462-8857
Mailing Address - Fax:612-206-8731
Practice Address - Street 1:1710 DOUGLAS DR N STE 107
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55422-4397
Practice Address - Country:US
Practice Address - Phone:612-462-8857
Practice Address - Fax:612-206-8731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities