Provider Demographics
NPI:1326846064
Name:AWAKEN ABA THERAPY LLC
Entity type:Organization
Organization Name:AWAKEN ABA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIKAFI
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-203-8746
Mailing Address - Street 1:6063 HUDSON RD STE 228
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4465
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6063 HUDSON RD STE 228
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4465
Practice Address - Country:US
Practice Address - Phone:612-203-8746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities