Provider Demographics
NPI:1265140644
Name:SHIFA AUTISM CENTER LLC
Entity type:Organization
Organization Name:SHIFA AUTISM CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YASMIIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDILAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-329-2798
Mailing Address - Street 1:3352 SHERMAN CT STE 202
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-5504
Mailing Address - Country:US
Mailing Address - Phone:651-329-2798
Mailing Address - Fax:
Practice Address - Street 1:3352 SHERMAN CT STE 202
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-5504
Practice Address - Country:US
Practice Address - Phone:651-329-2798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency