Provider Demographics
NPI:1801409099
Name:STAR AUTISM CENTER
Entity type:Organization
Organization Name:STAR AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABDINAJIB
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-806-9954
Mailing Address - Street 1:3400 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4000
Mailing Address - Country:US
Mailing Address - Phone:612-806-9954
Mailing Address - Fax:320-656-2882
Practice Address - Street 1:3333 W DIVISION ST STE 116
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4548
Practice Address - Country:US
Practice Address - Phone:612-806-9954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health