Organization
MINDBRIDGE AUTISM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMUD BORU (EXECUTIVE DIRECTOR)
(763) 528-0300
Entity
Organization
Contact information
Practice address
20731 HOLYOKE AVE # 909, LAKEVILLE, MN 55044-9825
(763) 528-0300
Mailing address
20731 HOLYOKE AVE # 909, LAKEVILLE, MN 55044-9825
(763) 528-0300
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
01/06/2025
Last updated
01/06/2025
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