Provider Demographics
NPI:1144038290
Name:HENNEPIN AUTISM CENTER INC
Entity type:Organization
Organization Name:HENNEPIN AUTISM CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SULEIMAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-259-7711
Mailing Address - Street 1:405 CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1032
Mailing Address - Country:US
Mailing Address - Phone:612-286-8091
Mailing Address - Fax:612-545-3760
Practice Address - Street 1:405 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1032
Practice Address - Country:US
Practice Address - Phone:612-259-7711
Practice Address - Fax:612-545-3760
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENNEPIN AUTISM CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health