Organization
ABIJAH'S ON THE BACKSIDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY MIXON MA (FOUNDER / CEO)
(715) 379-1370
Entity
Organization
Contact information
Practice address
1100 CANTERBURY RD S, SHAKOPEE, MN 55379-1867
(715) 379-1370
Mailing address
PO BOX 583, SHAKOPEE, MN 55379-0583
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/15/2024
Last updated
03/15/2024
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