Provider Demographics
NPI:1801164108
Name:EBYAN ADULT DAY CENTER LLC
Entity type:Organization
Organization Name:EBYAN ADULT DAY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESEDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:ISSE
Authorized Official - Last Name:ALI
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:612-313-0733
Mailing Address - Street 1:1810 RIVERSIDE AVE # LL
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1031
Mailing Address - Country:US
Mailing Address - Phone:612-313-0733
Mailing Address - Fax:612-313-8144
Practice Address - Street 1:1810 RIVERSIDE AVE # LL
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1031
Practice Address - Country:US
Practice Address - Phone:612-313-0733
Practice Address - Fax:612-313-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1049972-4-ADC261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care