Provider Demographics
NPI:1518709518
Name:AUTISM SOLUTIONS ACADEMY LLC
Entity type:Organization
Organization Name:AUTISM SOLUTIONS ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOUKTAR
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:BOUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-352-7523
Mailing Address - Street 1:5701 SHINGLE CREEK PKWY STE 550A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2467
Mailing Address - Country:US
Mailing Address - Phone:651-352-7523
Mailing Address - Fax:
Practice Address - Street 1:5701 SHINGLE CREEK PKWY STE 550A
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2467
Practice Address - Country:US
Practice Address - Phone:651-352-7523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center