Organization
FOUNTAIN AUTISM CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SACDIYO ABDI ALI (CEO)
(612) 636-8746
Entity
Organization
Contact information
Practice address
3628 PARK AVE, MINNEAPOLIS, MN 55407-2533
(612) 636-8746
Mailing address
3628 PARK AVE, MINNEAPOLIS, MN 55407-2533
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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