Provider Demographics
NPI:1861258469
Name:BRILLANT MINDS SERVICES
Entity type:Organization
Organization Name:BRILLANT MINDS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-494-4577
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2811
Mailing Address - Country:US
Mailing Address - Phone:763-339-8766
Mailing Address - Fax:651-389-9401
Practice Address - Street 1:200 LARPENTEUR AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2339
Practice Address - Country:US
Practice Address - Phone:763-339-8766
Practice Address - Fax:651-389-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health