Provider Demographics
NPI:1871276261
Name:SUBMERGE IN SENSORY
Entity type:Organization
Organization Name:SUBMERGE IN SENSORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:NAJMA
Authorized Official - Middle Name:ABDIWAHAB
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-212-9918
Mailing Address - Street 1:210 19TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-4312
Mailing Address - Country:US
Mailing Address - Phone:612-212-9918
Mailing Address - Fax:
Practice Address - Street 1:210 19TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-4312
Practice Address - Country:US
Practice Address - Phone:612-212-9918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health