Organization
ICOD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHUMA DKAE (CEO/OWNER)
(763) 614-0381
Entity
Organization
Contact information
Practice address
2616 87TH TRL N, BROOKLYN PARK, MN 55443-3742
(763) 614-0381
Mailing address
2616 87TH TRL N, BROOKLYN PARK, MN 55443-3742
(763) 614-0381
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
06/23/2023
Last updated
05/30/2025
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