Provider Demographics
NPI:1205968096
Name:ASIAN COMMUNITY CENTER, LLC
Entity type:Organization
Organization Name:ASIAN COMMUNITY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-379-0111
Mailing Address - Street 1:710 ARCADE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-4540
Mailing Address - Country:US
Mailing Address - Phone:651-379-0111
Mailing Address - Fax:
Practice Address - Street 1:710 ARCADE ST.
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106
Practice Address - Country:US
Practice Address - Phone:651-379-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1063125261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1063125OtherRAMSEY COUNTY
MN4981118Medicare ID - Type UnspecifiedMEDICA
MN3078790Medicare ID - Type UnspecifiedHEALTHPARTNERS
MN164403Medicare ID - Type UnspecifiedUCARE
MN270415300Medicare ID - Type UnspecifiedSTATE