Organization
KUBRA RESIDENTIAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAWSAR ABDI JAMA (OWNER)
(612) 224-4343
Entity
Organization
Contact information
Practice address
1711 W 143RD ST APT 120, BURNSVILLE, MN 55306-7989
(612) 224-4343
Mailing address
1711 W 143RD ST APT 120, BURNSVILLE, MN 55306-7989
(612) 224-4343
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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