Provider Demographics
NPI:1144083155
Name:SOUTHVIEW AUTISM SERVICES LLC
Entity type:Organization
Organization Name:SOUTHVIEW AUTISM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FATUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-808-0433
Mailing Address - Street 1:1865 OLD HUDSON RD # B2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1865 OLD HUDSON RD # B2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4308
Practice Address - Country:US
Practice Address - Phone:651-808-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities