# FUNDAMENTALS AUTISM CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104619121
- **Authorized official:** HUSSEIN MOHAMED ABSHIR (CEO)
- **Authorized official phone:** (206) 383-0514

## Contact information

- **Practice address:** 1250 MOORE LAKE DR E STE 200, FRIDLEY, MN 55432-5136
- **Practice address phone:** (206) 383-0514
- **Mailing address:** 1250 MOORE LAKE DR E STE 200, FRIDLEY, MN 55432-5136
- **Mailing address phone:** (206) 383-0514

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 05/22/2025
- **Last updated:** 05/22/2025