Organization
BEACON OF HOPE AUTISM CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TABITA A OMAR (OWNER)
(651) 363-0319
Entity
Organization
Contact information
Practice address
85 LIVINGSTON AVE APT 313, SAINT PAUL, MN 55107-5705
(651) 363-0319
Mailing address
85 LIVINGSTON AVE APT 313, SAINT PAUL, MN 55107-5705
(651) 363-0319
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/09/2024
Last updated
10/09/2024
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