Provider Demographics
NPI:1700528593
Name:UNIVERSAL THERAPY CENTER INC
Entity Type:Organization
Organization Name:UNIVERSAL THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDULSALAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JIBRIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-200-4159
Mailing Address - Street 1:2434 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1790
Mailing Address - Country:US
Mailing Address - Phone:651-200-4159
Mailing Address - Fax:
Practice Address - Street 1:2434 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1790
Practice Address - Country:US
Practice Address - Phone:651-200-4159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency