Provider Demographics
NPI:1386246056
Name:INFINITE AUTISM SUPPORT AND SERVICES LLC
Entity type:Organization
Organization Name:INFINITE AUTISM SUPPORT AND SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIRAHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-346-6053
Mailing Address - Street 1:501 DALE ST N STE 205
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1914
Mailing Address - Country:US
Mailing Address - Phone:612-346-6053
Mailing Address - Fax:
Practice Address - Street 1:501 DALE ST N STE 205
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1914
Practice Address - Country:US
Practice Address - Phone:612-346-6053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health