Provider Demographics
NPI:1093432395
Name:EDINA HEALTH COMPANY
Entity type:Organization
Organization Name:EDINA HEALTH COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:USAMA
Authorized Official - Middle Name:LIBAN
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-876-7414
Mailing Address - Street 1:2233 UNIVERSITY AVE W STE 421
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1629
Mailing Address - Country:US
Mailing Address - Phone:651-649-4444
Mailing Address - Fax:651-649-4445
Practice Address - Street 1:2233 UNIVERSITY AVE W STE 421
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1629
Practice Address - Country:US
Practice Address - Phone:651-649-4444
Practice Address - Fax:651-649-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8383431OtherMN DEPARTMENT OF REVENUE