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Organization
MIDWAY FAMILY SUPPORT
Active
Organization
MIDWAY FAMILY SUPPORT
Active
Other names
Midway
Organization subpart
No
Provider details
NPI number
Authorized official
SAMIRA MOHAMUD (CLINICAL TRAINEE)
(612) 707-4705
Entity
Organization
Contact information
Practice address
3629 95TH AVE NE, CIRCLE PINES, MN 55014-3843
(612) 707-4705
Mailing address
3629 95TH AVE NE, CIRCLE PINES, MN 55014-3843
(612) 707-4705
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
261QR0400X
Rehabilitation Clinic/Center
Primary
—
NULL
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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