Organization · NPI-2

Firstline Therapeutic Services LLC

Clinic/Center · Fridley, MN

NPI number1013688951
StatusActive
Last updated in NPPESApr 13, 2023

Details

NPI
1013688951
Entity type
Organization (NPI-2)
Legal business name
Firstline Therapeutic Services LLC
Organization subpart
No
Enumeration date
Sep 21, 2021
Certification date
Apr 13, 2023
Last updated
Apr 13, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Practice location

1250 Moore Lake Dr E Ste 205e
Fridley, MN 55432-5176

Phone 612-479-2085

Mailing address

1250 Moore Lake Dr E Ste 205e
Fridley, MN 55432-5176

Authorized official

Ayanle Abdihoosh
Owner
6124792085

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