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Organization
LIFE ALLIANCE, LLC
Active
Organization
LIFE ALLIANCE, LLC
Active
Other names
Life Alliance, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ABDISALLAM A ABDULLE (CEO)
(952) 777-4625
Entity
Organization
Contact information
Practice address
8609 LYNDALE AVE S, SUITE 213C, BLOOMIGTON, MN 55420-5542
(952) 777-4625
(952) 777-4627
Mailing address
8609 LYNDALE AVE S STE 213C, MINNEAPOLIS, MN 55420-2769
(612) 200-9466
(952) 777-4627
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
252Y00000X
Early Intervention Provider Agency
1087364-1-HCBS
MN
252Y00000X
Early Intervention Provider Agency
Primary
—
NULL
Other
Enumeration date
07/31/2017
Last updated
07/31/2017
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