Provider Demographics
NPI:1265268460
Name:FORMULA TRANSITIONAL HOUSING
Entity type:Organization
Organization Name:FORMULA TRANSITIONAL HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDIMAJID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-763-4563
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE 181
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2879
Mailing Address - Country:US
Mailing Address - Phone:507-479-1963
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE 181
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2879
Practice Address - Country:US
Practice Address - Phone:507-479-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty