Provider Demographics
NPI:1568293793
Name:HGHC DIRECT
Entity type:Organization
Organization Name:HGHC DIRECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEER SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:ABDI
Authorized Official - Suffix:
Authorized Official - Credentials:CPRS
Authorized Official - Phone:612-806-7460
Mailing Address - Street 1:PO BOX 20223
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55420-0223
Mailing Address - Country:US
Mailing Address - Phone:612-806-7460
Mailing Address - Fax:
Practice Address - Street 1:4224 W 141ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55420-0223
Practice Address - Country:US
Practice Address - Phone:612-806-7460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1545-0029Medicaid