Provider Demographics
NPI:1720500390
Name:AFRICAN CENTER OF INNOVATION
Entity Type:Organization
Organization Name:AFRICAN CENTER OF INNOVATION
Other - Org Name:AFRICAN CENTER OF INNOVATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HIIS
Authorized Official - Middle Name:BUNEYSTE
Authorized Official - Last Name:ILMI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:612-345-7823
Mailing Address - Street 1:2647 BLOOMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1187
Mailing Address - Country:US
Mailing Address - Phone:612-354-2758
Mailing Address - Fax:
Practice Address - Street 1:2647 BLOOMINGTON AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-354-2758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN924643800020OtherNONPROFIT ORGANIZATION