Provider Demographics
NPI:1487145546
Name:AFRICAN AMERICAN CHILD WELLNESS INSTITUTE
Entity type:Organization
Organization Name:AFRICAN AMERICAN CHILD WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAVADA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT-AKINSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:763-522-0100
Mailing Address - Street 1:9800 SHELARD PKWY STE 325
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6453
Mailing Address - Country:US
Mailing Address - Phone:763-522-0100
Mailing Address - Fax:763-588-0100
Practice Address - Street 1:9800 SHELARD PKWY STE 325
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6453
Practice Address - Country:US
Practice Address - Phone:763-522-0100
Practice Address - Fax:763-588-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)